MEDICARE: DR. AJIT ITTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	81890	AZ

General Provider Information

NPI Number	:	1013188234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJIT ITTY M.D.

Provider Business Mailing Address
First Line	:	3101 E CORTE DE LA RAQUETA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1072
Country	:	US
Telephone Number	:	520-548-1194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 N WARREN AVE RM 118
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-1006
Country	:	US
Telephone Number	:	520-626-6312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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