Individual
SOPHIA DITTRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Mailing address
W173N4992 CHESTNUT CT, MENOMONEE FALLS, WI 53051-6581
(262) 565-8805
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.086169
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2025
Last updated
06/03/2025
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