Provider Demographics
NPI:1013188234
Name:ITTY, AJIT (MD)
Entity Type:Individual
Prefix:DR
First Name:AJIT
Middle Name:
Last Name:ITTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 E CORTE DE LA RAQUETA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1072
Mailing Address - Country:US
Mailing Address - Phone:520-548-1194
Mailing Address - Fax:
Practice Address - Street 1:1609 N WARREN AVE RM 118
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-1006
Practice Address - Country:US
Practice Address - Phone:520-626-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81890207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine