Healthcare Provider Details

I. General information

NPI: 1497192116
Provider Name (Legal Business Name): MICHELE L BERTELLE DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6463 PARADISE CV
WEST PALM BEACH FL
33411-6462
US

IV. Provider business mailing address

6463 PARADISE CV
WEST PALM BEACH FL
33411-6462
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-9493
  • Fax: 786-364-1580
Mailing address:
  • Phone: 786-514-9493
  • Fax: 786-364-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3527
License Number StateFL

VIII. Authorized Official

Name: DR. MICHELE LYNN BERTELLE
Title or Position: OWNER
Credential: D.P.M
Phone: 786-514-9493