Healthcare Provider Details

I. General information

NPI: 1134386154
Provider Name (Legal Business Name): NOELLE BERTELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE SUITE 6300
DENVER CO
80218-1216
US

IV. Provider business mailing address

3333 S BANNOCK ST SUITE 350
ENGLEWOOD CO
80110-2432
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-5669
  • Fax: 303-839-1216
Mailing address:
  • Phone: 303-957-1310
  • Fax: 303-761-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number42213
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: