MEDICARE: MICHAEL T BERSTLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20725	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080078030	OTHER	IA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992781793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T BERSTLER MD

Provider Business Mailing Address
First Line	:	312 9TH ST SW
Second Line	:	SUITE 1200
City	:	WAVERLY
State	:	IA
Zip	:	50677-2929
Country	:	US
Telephone Number	:	319-352-4340
Fax Number	:	319-352-0745

Provider Business Practice Location Address
First Line	:	312 9TH ST SW
Second Line	:	SUITE 1200
City	:	WAVERLY
State	:	IA
Zip	:	50677-2929
Country	:	US
Telephone Number	:	319-352-4340
Fax Number	:	319-352-0745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/22/2012

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Directions to “ MICHAEL T BERSTLER MD” Practice Location

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