Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 6283851 | WI |
Y | 208600000X | Surgeon | 6283851 | WI |
NPI | 1003260050 |
---|---|
Provider Name | Dina Marie Pitta |
First Address | Madison, WI 53792-0001 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2016 |
Last Update Date | 12/01/2017 |