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

Table of content: (NPI 1295092997)

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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