Provider Demographics
NPI:1487926762
Name:GITTLI, ROBERT P (CAC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:GITTLI
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 CROSS BILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1207
Mailing Address - Country:US
Mailing Address - Phone:502-338-7780
Mailing Address - Fax:
Practice Address - Street 1:3219 CROSS BILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1207
Practice Address - Country:US
Practice Address - Phone:502-338-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY#TAC59171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist