Provider Demographics
NPI:1154328417
Name:BIELITZ, EDITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDITHA
Middle Name:
Last Name:BIELITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BAYOU BLVD.
Mailing Address - Street 2:STE 52A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-476-6060
Mailing Address - Fax:850-476-6070
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:STE 52A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-476-6060
Practice Address - Fax:850-476-6070
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65517207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07-01149OtherUNITED HEALTHCARE
FL01584OtherBLUE CROSS BLUE SHEILD FL
FL07-01149OtherUNITED HEALTHCARE