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NPI Code Detail

MEDICARE: DR. MARY IRIA PITARO M.D.

MEDICARE: DR. MARY IRIA PITARO 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
1207R00000XInternal Medicine PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10031604392OTHERILBCBS

General Provider Information

NPI Number : 1225196124
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY IRIA PITARO M.D.
Provider Business Mailing Address
First Line : 9050 W 81ST ST
Second Line :
City : JUSTICE
State : IL
Zip : 60458-1350
Country : US
Telephone Number : 708-563-0088
Fax Number : 708-563-0585
Provider Business Practice Location Address
First Line : 9050 W 81ST ST
Second Line :
City : JUSTICE
State : IL
Zip : 60458-1350
Country : US
Telephone Number : 708-563-0088
Fax Number : 708-563-0585
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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