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1992721898 NPI number — RICHARD H BERTENSHAW JR. MD

NPI Number: 1992721898
Health Care Provider/Practitioner: RICHARD H BERTENSHAW JR. MD

Information about “1992721898” NPI (RICHARD H BERTENSHAW JR. MD) exists in 1992721898 in HTML format HTML  |  1992721898 in plain Text format TXT  |  1992721898 in PDF (Portable Document Format) PDF  |  1992721898 in an XML format XML  formats.

NPI Number : 1992721898 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992721898",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERTENSHAW",
    "FirstName": "RICHARD",
    "MiddleName": "H",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7545 WILTON RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DARIEN",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60561-6702",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-921-6053",
    "MailingAddressFaxNumber": "877-992-6901",
    "FirstLinePracticeLocationAddress": "7545 WILTON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DARIEN",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60561-6702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-921-6053",
    "PracticeLocationAddressFaxNumber": "877-992-6901",
    "EnumerationDate": "07/14/2006",
    "LastUpdateDate": "08/03/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RE0101X",
        "TaxonomyName": "Endocrinology, Diabetes & Metabolism Physician",
        "LicenseNumber": "036074851",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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