Healthcare Provider Details

I. General information

NPI: 1578504551
Provider Name (Legal Business Name): VINCENT J BERTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD PHASE II, SUITE 201
CLEVELAND OH
44130-3480
US

IV. Provider business mailing address

18660 BAGLEY RD PHASE II, SUITE 201
CLEVELAND OH
44130-3480
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-0100
  • Fax: 440-243-7118
Mailing address:
  • Phone: 440-243-0100
  • Fax: 440-243-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number045524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: