Provider Demographics
NPI:1386852911
Name:GHITIS, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GHITIS
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 950131
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0131
Mailing Address - Country:US
Mailing Address - Phone:502-804-4766
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:311 PAGODA OAK
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78230-5619
Practice Address - Country:US
Practice Address - Phone:804-502-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1065802085R0202X
KY499632085R0202X
TXQ84842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY49963OtherKENTUCKY LICENSE
FLME106580OtherFLORIDA LICENCE
TXQ8484OtherTEXAS LICENSE
FL002304500Medicaid