Basic Information
| Provider Information | |||||||||
| NPI: | 1942723366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DITTMAR | ||||||||
| FirstName: | DANIELA | ||||||||
| MiddleName: | CRISTINA | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 W POLK ST APT 1708 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606053592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125229827 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1501 S CALIFORNIA AVE STE L1026 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606081732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732576097 | ||||||||
| FaxNumber: | 7732576045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2017 | ||||||||
| LastUpdateDate: | 11/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.150411 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.