Bertagnoli, Mark W
Bertagnoli, Mark W is an individual health care provider with primary practice located at 835 S Van Buren St , Green Bay WI 54301-3526. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine, which is considered as his primary health care specialty. Bertagnoli, Mark W can be contacted via phone (920) 433-8360.Contact Information
Primary practice address
835 S Van Buren St
Green Bay WI 54301-3526
Phone: (920) 433-8360
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine | 2080N0001X | 40649-020 | Wisconsin |
Profile Details
| NPI number | 1669443610 |
|---|---|
| LBN Legal business name | Bertagnoli, Mark W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 29th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669443610 | NPPES |
| Michigan | MEDICAID | 4094435 | |
| Michigan | MEDICAID | 32539200 |
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