1356917504 NPI number — MRS. KARLYLE GENEVIEVE BISTAS M.D.

Table of content: MRS. KARLYLE GENEVIEVE BISTAS M.D. (NPI 1356917504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356917504 NPI number — MRS. KARLYLE GENEVIEVE BISTAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISTAS
Provider First Name:
KARLYLE
Provider Middle Name:
GENEVIEVE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
KARLYLE
Provider Other Middle Name:
GENEVIEVE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356917504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37436 SPRING LN.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-3714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-790-6248
Provider Business Mailing Address Fax Number:
313-933-8501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DETROIT MEDICAL CENTER GME OFFICE
Provider Second Line Business Practice Location Address:
4201 ST. ANTOINE UHC-9C
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-966-0463
Provider Business Practice Location Address Fax Number:
313-933-8501
Provider Enumeration Date:
05/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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