Healthcare Provider Details

I. General information

NPI: 1568997781
Provider Name (Legal Business Name): STEPHEN MICHAEL BERTUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 W JUDGE PEREZ DR STE 3100
CHALMETTE LA
70043-1740
US

IV. Provider business mailing address

8050 W JUDGE PEREZ DR STE 3100
CHALMETTE LA
70043-1740
US

V. Phone/Fax

Practice location:
  • Phone: 504-304-2800
  • Fax: 504-826-9650
Mailing address:
  • Phone: 504-304-2800
  • Fax: 504-826-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number322801
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: