Provider Demographics
NPI:1447210711
Name:FITZ, ROBERT MARK (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:FITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-7210
Mailing Address - Fax:859-301-7216
Practice Address - Street 1:1808 BRISTOW DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-3513
Practice Address - Country:US
Practice Address - Phone:859-301-7210
Practice Address - Fax:859-301-7216
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33542208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2261887OtherMEDICAID
KY64037591Medicaid
KYG66996Medicare UPIN
KY080183012Medicare PIN
KY0364927Medicare PIN