Provider Demographics
NPI:1053357624
Name:GIOLITTO, JUDITH ANN (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:GIOLITTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2381
Mailing Address - Country:US
Mailing Address - Phone:815-395-4516
Mailing Address - Fax:815-395-4600
Practice Address - Street 1:4423 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-1655
Practice Address - Country:US
Practice Address - Phone:815-394-1391
Practice Address - Fax:815-226-0114
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL834340OtherMEDICARE GROUP PTAN
IL553180OtherMEDICARE GROUP NUMBER
IL036051509Medicaid
IL553180027OtherMEDICARE INDIVIDUAL ID
IL080047788Medicare ID - Type UnspecifiedRR INDIVIDUAL #
IL846930Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL553180027OtherMEDICARE INDIVIDUAL ID
ILC37286Medicare UPIN
IL801570Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILL76786Medicare ID - Type Unspecified
IL036051509Medicaid
IL834340020Medicare PIN
IL553180OtherMEDICARE GROUP NUMBER
ILL73365Medicare ID - Type Unspecified
IL834340OtherMEDICARE GROUP PTAN
IL834340Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILL77879Medicare ID - Type Unspecified
ILL73370Medicare ID - Type Unspecified