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General NPI Number Information
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NPI Number | 1528011319
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Entity Type | Individual
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Provider Name | HEIDI BERTRAM MD
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 4201 W MEDICAL CENTER DR
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City | MCHENRY
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State | IL
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Zip | 60050-8409
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Country | US
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Telephone | 815-759-4806
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Fax | 815-759-4867
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Provider Business Mailing Address
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Address Line | 35558 N KENNETH DR
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City | LAKE VILLA
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State | IL
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Zip | 60046-7152
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Country | US
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Telephone | 847-543-4160
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 01051042A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 036127213
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License Number State | IL
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