Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 003529 | KY |
NPI | 1033115753 |
---|---|
Provider Name | Mr. Craig F Bertsch |
First Address | Alexandria, KY 41001-9519 |
Second Address | Wilder, KY 41076-9189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8700147500 | (05) | KY |
S85564 | (02) | KY |