Provider Demographics
NPI:1487877973
Name:BITAR, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:BITAR
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 1:47389 VAN DYKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
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 AVENUE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010599502080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4160147Medicaid
MI4160147Medicaid