Provider Demographics
NPI:1730270661
Name:MOHAMMAD BITAR MD PC
Entity type:Organization
Organization Name:MOHAMMAD BITAR MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ANAS
Authorized Official - Last Name:BITAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-739-8030
Mailing Address - Street 1:47389 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3363
Mailing Address - Country:US
Mailing Address - Phone:586-739-8030
Mailing Address - Fax:586-739-8333
Practice Address - Street 1:47389 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-3363
Practice Address - Country:US
Practice Address - Phone:586-739-8030
Practice Address - Fax:586-739-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010599502080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4160147.10Medicaid
MI4160147Medicaid
MIG31996Medicare UPIN