Provider Demographics
NPI:1215318787
Name:BISTOLARIDES, JAMES CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:BISTOLARIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:999 N 92ND ST STE C465
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:999 N 92ND ST STE C465
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4875
Practice Address - Country:US
Practice Address - Phone:414-266-6700
Practice Address - Fax:414-266-3905
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI76590-20208000000X
MI4301114154208000000X
WI76597-202080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics