Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 35.086345 | OH |
Y | 2080P0204X | Pediatric Emergency Doctor | DR.0062070 | CO |
NPI | 1235166802 |
---|---|
Provider Name | Matthew R Mittiga |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 23/08/2019 |