Healthcare Provider Details

I. General information

NPI: 1891006235
Provider Name (Legal Business Name): MICHELE LYNN BERTELLE-SEMMA D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WELCH RD SUITE #10
COMMERCE TOWNSHIP MI
48390-2864
US

IV. Provider business mailing address

7636 GOSHEN DR
W BLOOMFIELD MI
48322-5003
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 TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3527
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3527
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002578
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002578
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: