Healthcare Provider Details

I. General information

NPI: 1063672194
Provider Name (Legal Business Name): MICHAEL F DITILLO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE FL 5
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

320 E NORTH AVE FL 5
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-6466
  • Fax: 412-359-8639
Mailing address:
  • Phone: 412-359-6466
  • Fax: 412-359-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS017021
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: