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Individual

DR. PETER BISTOLARIDES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4201 CAMPUS RIDGE DRIVE, MIDLAND, MI 48640
(989) 839-1795
(989) 839-1785
Mailing address
4201 CAMPUS RIDGE DRIVE, MIDLAND, MI 48640
(989) 839-1795
(989) 839-1785

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301064856
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020G361410
BCBSM GROUP PIN
MI
01
0993608
HEALTHPLUS OF MICHIGAN
05
104905069
MI
01
156543
GREAT LAKES HEALTH PLAN
01
P00348487
RAILROAD MEDICARE
01
PB064856
STATE LICENSE
MI
Enumeration date
11/18/2005
Last updated
11/03/2016
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