Basic Information
| Provider Information | |||||||||
| NPI: | 1336129139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIACALONE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485021641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104064246 | ||||||||
| FaxNumber: | 8104246029 | ||||||||
| Practice Location | |||||||||
| Address1: | G3375 S SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485291244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107436830 | ||||||||
| FaxNumber: | 8107437086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301032442 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | MG032442 | 01 | MI | HEALTH PLUS AND BCBS | OTHER | 4832365 | 05 | MI | MEDICAID | 0B56065021 | 01 | MI | MEDICARE ID | OTHER |