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Individual
DR. MICHAEL ITIDIARE
Active
Individual
DR. MICHAEL ITIDIARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O., M.B.S
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0102208235
VA
207R00000X
Internal Medicine Physician
6450
TN
207RG0100X
Gastroenterology Physician
0102208235
VA
207RG0100X
Gastroenterology Physician
Primary
25MB10130600
NJ
207RG0100X
Gastroenterology Physician
6450
TN
Other
Enumeration date
07/16/2013
Last updated
02/25/2026
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