Individual
DR. SHAUN T ITTIARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 S MICHIGAN AVE STE 212, CHICAGO, IL 60616-2859
(312) 567-2795
(800) 707-4890
Mailing address
PO BOX 166516, CHICAGO, IL 60616-6516
(312) 567-2795
(800) 707-4890
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036127360
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
036.127360
IL
Other
Enumeration date
07/30/2007
Last updated
07/05/2023
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