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NPI Code Detail

MEDICARE: DR. THEETHAYE LONAPPAN ITTIARA M.D

MEDICARE: DR. THEETHAYE LONAPPAN ITTIARA 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
12084P0800XPsychiatry Physician4301031889MI

General Provider Information

NPI Number : 1174585475
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THEETHAYE LONAPPAN ITTIARA M.D
Provider Business Mailing Address
First Line : 5442 PINE VIEW DR
Second Line :
City : YPSILANTI
State : MI
Zip : 48197-8963
Country : US
Telephone Number : 734-485-0868
Fax Number :
Provider Business Practice Location Address
First Line : 142 E MAUMEE ST
Second Line :
City : ADRIAN
State : MI
Zip : 49221-2735
Country : US
Telephone Number : 517-263-5810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 07/08/2007

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