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General NPI Number Information
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NPI Number | 1497192116
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Entity Type | Organization
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Legal Business Name | MICHELE L BERTELLE DPM, LLC
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 6463 PARADISE CV
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-6462
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Country | US
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Telephone | 786-514-9493
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Fax | 786-364-1580
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Provider Business Mailing Address
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Address Line | 6463 PARADISE CV
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-6462
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Country | US
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Telephone | 786-514-9493
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Fax | 786-364-1580
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELE LYNN BERTELLE
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Credential | D.P.M
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Telephone | 786-514-9493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO 3527
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License Number State | FL
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