Healthcare Provider Details

I. General information

NPI: 1215318787
Provider Name (Legal Business Name): JAMES CHRISTOPHER BISTOLARIDES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N 92ND ST STE C465
MILWAUKEE WI
53226-4875
US

IV. Provider business mailing address

999 N 92ND ST STE C465
MILWAUKEE WI
53226-4875
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6700
  • Fax: 414-266-3905
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number76590-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301114154
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number76597-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: