Provider Demographics
NPI:1184815987
Name:MARY I. PITARO, M.D., LTD.
Entity Type:Organization
Organization Name:MARY I. PITARO, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:IRIA
Authorized Official - Last Name:PITARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-563-0088
Mailing Address - Street 1:9050 W 81ST ST
Mailing Address - Street 2:
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-1350
Mailing Address - Country:US
Mailing Address - Phone:708-563-0088
Mailing Address - Fax:708-563-0585
Practice Address - Street 1:9050 W 81ST ST
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1350
Practice Address - Country:US
Practice Address - Phone:708-563-0088
Practice Address - Fax:708-563-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31604392OtherBCBS OF ILLINOIS
E74442Medicare UPIN
IL985750Medicare PIN