Healthcare Provider Details

I. General information

NPI: 1083657555
Provider Name (Legal Business Name): DAVID EUGENE BERTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/07/2023
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SCHEURING RD
DE PERE WI
54115-1067
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-5278
  • Fax: 920-683-2131
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number29339020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number29339020
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number29339020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: