Healthcare Provider Details

I. General information

NPI: 1992026439
Provider Name (Legal Business Name): KRAIG EDWARD BERTRAM II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SANTA FE AVE SUITE 100
SALINA KS
67401-4189
US

IV. Provider business mailing address

501 S SANTA FE AVE SUITE 100
SALINA KS
67401-4189
US

V. Phone/Fax

Practice location:
  • Phone: 785-825-2273
  • Fax: 785-825-2275
Mailing address:
  • Phone: 785-825-2273
  • Fax: 785-825-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number05-36706
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: