| Theethaye Ittiara Md Pc | |
|
142 E Maumee Street Suite 3 Adrian MI 49221-3619 | |
| (517) 263-5810 | |
| Not Available |
| Full Name | Theethaye Ittiara Md Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 142 E Maumee Street Suite 3, Adrian, Michigan |
| Authorized Official Name and Position | Theethaye L Ittiara (MD) |
| Authorized Official Contact | 5172635810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theethaye Ittiara Md Pc 142 E Maumee Street Suite 3 Adrian MI 49221-3619 Ph: (517) 263-5810 | Theethaye Ittiara Md Pc 142 E Maumee Street Suite 3 Adrian MI 49221-3619 Ph: (517) 263-5810 |
| NPI Number | 1881968394 |
|---|---|
| Provider Enumeration Date | 03/01/2012 |
| Last Update Date | 03/01/2012 |
| Medicare PECOS PAC ID | 8325057474 |
|---|---|
| Medicare Enrollment ID | O20060418000372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881968394 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 4301031889 (Michigan) | Primary |
| Provider Name | Theethaye L Ittiara |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174585475 PECOS PAC ID: 0143280560 Enrollment ID: I20041012000086 |
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