Provider Demographics
NPI:1689707291
Name:GRITTMANN, ROBERT STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:GRITTMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 KIMBALL AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5014
Mailing Address - Country:US
Mailing Address - Phone:319-272-2340
Mailing Address - Fax:319-272-2347
Practice Address - Street 1:2055 KIMBALL AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5014
Practice Address - Country:US
Practice Address - Phone:319-272-2340
Practice Address - Fax:319-272-2347
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2031146Medicaid
A02705Medicare UPIN
IA2031146Medicaid