MEDICARE: JUNIOR WILLIAM PITTACK MD

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	2084P0800X	Psychiatry Physician	ME89943	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME89943	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023053931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNIOR WILLIAM PITTACK MD

Provider Business Mailing Address
First Line	:	11320 SW 112TH CIRCLE LN E
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-3861
Country	:	US
Telephone Number	:	305-254-5961
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 W 20TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5874
Country	:	US
Telephone Number	:	305-825-0300
Fax Number	:

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	10/15/2013

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