Organization
MARY I. PITARO, M.D., LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY IRIA PITARO M.D. (PRESIDENT)
(708) 563-0088
Entity
Organization
Contact information
Practice address
9050 W 81ST ST, JUSTICE, IL 60458-1350
(708) 563-0088
(708) 563-0585
Mailing address
9050 W 81ST ST, JUSTICE, IL 60458-1350
(708) 563-0088
(708) 563-0585
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31604392
BCBS OF ILLINOIS
IL
Enumeration date
08/06/2007
Last updated
08/06/2007
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