NPI Code Detail JSON Logo

1528011319 NPI number — HEIDI BERTRAM MD

NPI Number: 1528011319
Health Care Provider/Practitioner: HEIDI BERTRAM MD

Information about “1528011319” NPI (HEIDI BERTRAM MD) exists in 1528011319 in HTML format HTML  |  1528011319 in plain Text format TXT  |  1528011319 in PDF (Portable Document Format) PDF  |  1528011319 in an XML format XML  formats.

NPI Number : 1528011319 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528011319",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERTRAM",
    "FirstName": "HEIDI",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "35558 N KENNETH DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE VILLA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60046-7152",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-543-4160",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4201 W MEDICAL CENTER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MCHENRY",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60050-8409",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-759-4806",
    "PracticeLocationAddressFaxNumber": "815-759-4867",
    "EnumerationDate": "05/19/2006",
    "LastUpdateDate": "08/17/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207ZP0102X",
          "TaxonomyName": "Anatomic Pathology & Clinical Pathology Physician",
          "LicenseNumber": "01051042A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207ZP0102X",
          "TaxonomyName": "Anatomic Pathology & Clinical Pathology Physician",
          "LicenseNumber": "036127213",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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