Provider Demographics
NPI:1740077445
Name:DITKOFF, TALIA RUTH
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:RUTH
Last Name:DITKOFF
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 N WESTERN AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1774
Mailing Address - Country:US
Mailing Address - Phone:312-633-5841
Mailing Address - Fax:
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:STE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1774
Practice Address - Country:US
Practice Address - Phone:312-633-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program