Provider Demographics
NPI:1821222100
Name:BITAR, GERARD GEORGES (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:GEORGES
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 1:2329 N DIRKSEN PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-1403
Mailing Address - Country:US
Mailing Address - Phone:217-789-1403
Mailing Address - Fax:217-789-1825
Practice Address - Street 1:2329 N DIRKSEN PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1403
Practice Address - Country:US
Practice Address - Phone:217-789-1403
Practice Address - Fax:217-789-1825
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007019080207Q00000X
IL036126303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine