Healthcare Provider Details

I. General information

NPI: 1053986018
Provider Name (Legal Business Name): KYLE JOHN BERTEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 AUBURN WAY N
AUBURN WA
98002-4117
US

IV. Provider business mailing address

923 AUBURN WAY N
AUBURN WA
98002-4117
US

V. Phone/Fax

Practice location:
  • Phone: 253-351-3900
  • Fax:
Mailing address:
  • Phone: 253-351-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT222901
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: