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NPI Code Detail

MEDICARE: ANDREA DIANE ITZKOWITZ M.D.

MEDICARE: ANDREA DIANE ITZKOWITZ 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 PhysicianME51683FL
2207R00000XInternal Medicine Physician2012011172MO

General Provider Information

NPI Number : 1285696831
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA DIANE ITZKOWITZ M.D.
Provider Business Mailing Address
First Line : PO BOX 1239
Second Line :
City : TROY
State : MI
Zip : 48099-1239
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8710 MANCHESTER RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63144-2724
Country : US
Telephone Number : 314-961-3570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 10/14/2015

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