Organization
THEETHAYE L. ITTIARA, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEETHAYE L ITTIARA M.D. (OWNER)
(517) 263-5810
Entity
Organization
Contact information
Practice address
142 E MAUMEE ST, ADRIAN, MI 49221-2735
(517) 263-5810
(517) 263-5810
Mailing address
142 E MAUMEE ST, ADRIAN, MI 49221-2735
(517) 263-5810
(517) 263-5810
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
TI031889
MI
Other
Enumeration date
06/24/2008
Last updated
06/24/2008
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