Organization
J L GIACCHINO/S D DEMOREST MD ASSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH L GIACCHINO JR. (OWNER)
(708) 343-2500
Entity
Organization
Contact information
Practice address
1252 WINSTON PLAZA, MELROSE PARK, IL 60160-1507
(708) 343-2500
(708) 343-9545
Mailing address
8383 W BELMONT AVE, SUITE 307, RIVER GROVE, IL 60171
(708) 453-1325
(708) 453-1401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21608664
BLUE CROSS/BLUE SHIELD
IL
01
—
737320
MEDICARE
IL
Enumeration date
10/16/2007
Last updated
06/18/2008
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