Individual
SUJIT ITTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 E MISSOURI AVE, PHOENIX, AZ 85014-2709
(602) 222-2221
(602) 265-5077
Mailing address
4800 N 22ND ST STE 210, PHOENIX, AZ 85016-4963
(602) 977-6190
(602) 265-5077
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
51210
AZ
207WX0107X
Retina Specialist (Ophthalmology) Physician
51210
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054762
—
AZ
05
—
0A1252650
—
CA
Enumeration date
06/17/2009
Last updated
01/26/2022
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