Healthcare Provider Details

I. General information

NPI: 1568428886
Provider Name (Legal Business Name): SAMI M BITTAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 WILLOW SPRINGS RD SUITE 440
LA GRANGE HIGHLANDS IL
60525-6537
US

IV. Provider business mailing address

5201 WILLOW SPRINGS RD SUITE 440
LA GRANGE HIGHLANDS IL
60525-6537
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-4667
  • Fax: 708-354-6454
Mailing address:
  • Phone: 708-354-4667
  • Fax: 708-354-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036075257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: