Healthcare Provider Details

I. General information

NPI: 1477726610
Provider Name (Legal Business Name): J.E.BERTOLINI ,M.D. SC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N HAMMES AVE SUITE D
JOLIET IL
60435-8129
US

IV. Provider business mailing address

202 N HAMMES AVE SUITE D
JOLIET IL
60435-8129
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-4104
  • Fax: 815-741-4135
Mailing address:
  • Phone: 815-741-4104
  • Fax: 815-741-4135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY E BERTOLINI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-741-4104