Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 01074236A | IN |
N | 2086X0206X | Surgical Oncologist | 01074236A | IN |
NPI | 1386804987 |
---|---|
Provider Name | Dr. Todd Bertrand |
First Address | Detroit, MI 48278-1076 |
Second Address | Mooresville, IN 46158-1788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000883869 | ANTHEM BCBS PIN (01) | IN |
201245330 | (05) | IN |