Provider Demographics
NPI:1770793416
Name:BITAR, EILIANA (MD)
Entity type:Individual
Prefix:
First Name:EILIANA
Middle Name:
Last Name:BITAR
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 1:14461 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3174
Mailing Address - Country:US
Mailing Address - Phone:313-551-4008
Mailing Address - Fax:313-254-2987
Practice Address - Street 1:14461 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3174
Practice Address - Country:US
Practice Address - Phone:313-551-4008
Practice Address - Fax:313-254-2987
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084233207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225332505Medicaid