Provider Demographics
NPI:1356917504
Name:BISTAS, KARLYLE GENEVIEVE (MD)
Entity type:Individual
Prefix:MRS
First Name:KARLYLE
Middle Name:GENEVIEVE
Last Name:BISTAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARLYLE
Other - Middle Name:GENEVIEVE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DETROIT MEDICAL CENTER GME OFFICE
Mailing Address - Street 2:4201 ST. ANTOINE UHC-9C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-0463
Mailing Address - Fax:313-933-8501
Practice Address - Street 1:DETROIT MEDICAL CENTER GME OFFICE
Practice Address - Street 2:4201 ST. ANTOINE UHC-9C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-966-0463
Practice Address - Fax:313-933-8501
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program