Basic Information
| Provider Information | |||||||||
| NPI: | 1508929498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARGARETTA E. GENNANTONIO MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1144 MOMENTUM PL | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606895311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003575728 | ||||||||
| FaxNumber: | 9372912962 | ||||||||
| Practice Location | |||||||||
| Address1: | 5467 CEDAR VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450408693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133363141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | GENNANTONIO | ||||||||
| AuthorizedOfficialFirstName: | MARGARETTA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5133363141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.