Provider Demographics
NPI:1568428886
Name:BITTAR, SAMI M (MD)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:M
Last Name:BITTAR
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 1:5201 WILLOW SPRINGS RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6537
Mailing Address - Country:US
Mailing Address - Phone:708-354-4667
Mailing Address - Fax:708-354-6454
Practice Address - Street 1:5201 WILLOW SPRINGS RD
Practice Address - Street 2:SUITE 440
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-354-4667
Practice Address - Fax:708-354-6454
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360752572086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075257Medicaid
IL1608036OtherBC/BS PROVIDER #
IL240005077Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
IL384190Medicare ID - Type UnspecifiedMEDICARE #
IL1608036OtherBC/BS PROVIDER #