MEDICARE: CRISTINA TITA 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
1	207R00000X	Internal Medicine Physician	4301082141	MI
2	207RC0000X	Cardiovascular Disease Physician	4301082141	MI
3	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	4301082141	MI

General Provider Information

NPI Number	:	1861605362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA TITA M.D.

Provider Business Mailing Address
First Line	:	2799 W GRAND BLVD
Second Line	:	DEPT OF CARDIOLOGY
City	:	DETROIT
State	:	MI
Zip	:	48202-2608
Country	:	US
Telephone Number	:	313-916-2966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E MICHIGAN AVE STE 100
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1800
Country	:	US
Telephone Number	:	517-205-3345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	06/22/2020

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