Individual
SHANE MICHAEL DITTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
416 E MONROE ST, STE. 200, SOUTH BEND, IN 46601-2371
(574) 232-8119
(574) 288-0235
Mailing address
416 E MONROE ST, STE. 200, SOUTH BEND, IN 46601-2371
(574) 232-8119
(574) 288-0235
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01060795
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200859480
—
IN
01
—
236080EE
MEDICARE
IN
Enumeration date
05/07/2007
Last updated
10/06/2008
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