Provider Demographics
NPI:1942723366
Name:DITTMAR, DANIELA CRISTINA (MD)
Entity Type:Individual
Prefix:MISS
First Name:DANIELA
Middle Name:CRISTINA
Last Name:DITTMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W POLK ST APT 1708
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3592
Mailing Address - Country:US
Mailing Address - Phone:312-522-9827
Mailing Address - Fax:
Practice Address - Street 1:1501 S CALIFORNIA AVE STE L1026
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1732
Practice Address - Country:US
Practice Address - Phone:773-257-6097
Practice Address - Fax:773-257-6045
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.150411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine