Individual
BRYANT T ITTIARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
18707 ECORSE RD, ALLEN PARK, MI 48101-2255
(734) 682-3309
(734) 682-1488
Mailing address
416 JAMES CIR, ROYAL OAK, MI 48067-4545
(734) 604-0017
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
L1593593
MI
207LP2900X
Pain Medicine (Anesthesiology) Physician
5101017919
MI
208VP0014X
Interventional Pain Medicine Physician
Primary
5101017919
MI
Other
Enumeration date
10/23/2009
Last updated
01/07/2019
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