Individual
DR. JONATHAN EDWARDS DITTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4440 PORTAGE AVE, SOUTH BEND, IN 46628-9570
(574) 204-6200
(574) 239-1520
Mailing address
4440 PORTAGE AVE, SOUTH BEND, IN 46628-9570
(574) 204-6200
(574) 239-1520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01082081A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/04/2016
Last updated
06/28/2019
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