Individual
MICHAEL THOMAS GINNETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1015 S MERCER AVE STE GF7, BLOOMINGTON, IL 61701-7107
(309) 660-8442
Mailing address
1015 S MERCER AVE STE GF7, BLOOMINGTON, IL 61701-7107
(309) 660-8442
(309) 846-6155
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036.156711
IL
207N00000X
Dermatology Physician
R-11187
IA
390200000X
Student in an Organized Health Care Education/Training Program
R-11187
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
05/15/2017
Last updated
11/23/2022
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