Individual
AMIR BISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 E CAPITOL DR, APPLETON, WI 54911-8735
(920) 364-3600
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 364-3600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT206839
PA
207RH0003X
Hematology & Oncology Physician
Primary
67487
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100068956
—
WI
Enumeration date
07/31/2014
Last updated
12/28/2023
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