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General NPI Number Information
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NPI Number | 1194700419
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Entity Type | Individual
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Provider Name | MICHELLE MARIE BERTSCH MD
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Gender | Female
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 131 MEDICAL PARK RD STE 306
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City | MOORESVILLE
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State | NC
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Zip | 28117
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Country | US
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Telephone | 704-660-2610
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Fax | 704-660-2611
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Provider Business Mailing Address
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Address Line | 131 MEDICAL PARK RD STE 306
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City | MOORESVILLE
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State | NC
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Zip | 28117-8525
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Country | US
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Telephone | 704-660-2610
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Fax | 704-660-2611
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 200200644
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License Number State | NC
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