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General NPI Number Information
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NPI Number | 1144316910
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Entity Type | Individual
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Provider Name | MUHAMMAD M ITANI M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 700 S PARK ST DEAN ST. MARY'S OUTPATIENT CENTER
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City | MADISON
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State | WI
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Zip | 53715-1830
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Country | US
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Telephone | 608-258-6975
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Fax | 608-258-5222
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Provider Business Mailing Address
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Address Line | 700 S PARK ST DEAN ST. MARY'S OUTPATIENT CENTER
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City | MADISON
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State | WI
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Zip | 53715-1830
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Country | US
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Telephone | 608-258-6975
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Fax | 608-258-5222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 46126-020
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License Number State | WI
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