Individual
JUNIOR WILLIAM PITTACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4175 W 20TH AVE, HIALEAH, FL 33012-5874
(305) 825-0300
Mailing address
11320 SW 112TH CIRCLE LN E, MIAMI, FL 33176-3861
(305) 254-5961
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME89943
FL
2084P0804X
Child & Adolescent Psychiatry Physician
ME89943
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275495900
—
FL
Enumeration date
06/17/2006
Last updated
10/15/2013
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