Provider Demographics
NPI:1174674824
Name:PITTS, GLORIA (DO)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15659 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2188
Mailing Address - Country:US
Mailing Address - Phone:248-569-4290
Mailing Address - Fax:248-569-9478
Practice Address - Street 1:15659 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2188
Practice Address - Country:US
Practice Address - Phone:248-569-4290
Practice Address - Fax:248-569-9478
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010090792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry