Provider Demographics
NPI:1073558987
Name:BILTEK, BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:BILTEK
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 1:901 N LAKE DESTINY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 N LAKE DESTINY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4844
Practice Address - Country:US
Practice Address - Phone:407-200-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG13949Medicare UPIN
FL35242XMedicare ID - Type UnspecifiedMEDIDARE NUMBER