Individual
MR. ANTONIO P. GIANNELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
4052 LEGACY PKWY, SUITE 200, LANSING, MI 48911-4285
(517) 272-9700
Mailing address
4052 LEGACY PKWY, SUITE 200, LANSING, MI 48911-4285
(517) 272-9700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1821562
MI
363A00000X
Physician Assistant
Primary
5601001053
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750472734
GROUP NPI NUMBER
MI
01
—
1821562
LICENSE
MI
01
—
TI035364
SUPERVISOR IGNACZAK
MI
Enumeration date
11/07/2006
Last updated
05/04/2021
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