Provider Demographics
NPI:1356543466
Name:MCKITTRICK, ROBERT EMMETT JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMMETT
Last Name:MCKITTRICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:770 CLAUGHTON ISLAND DR
Mailing Address - Street 2:#514
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2617
Mailing Address - Country:US
Mailing Address - Phone:401-626-6640
Mailing Address - Fax:
Practice Address - Street 1:11921 SOUTH DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:401-626-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127290208D00000X
RIMD10184208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice