MEDICARE: JOHN BERTSCHLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4272	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00112875	OTHER	OH	RAILROAD MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000152019	OTHER		ANTHEM

General Provider Information

NPI Number	:	1275539124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BERTSCHLER PH.D.

Provider Business Mailing Address
First Line	:	1389 APPLE VALLEY CT
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-3640
Country	:	US
Telephone Number	:	440-262-3700
Fax Number	:	440-262-3702

Provider Business Practice Location Address
First Line	:	1389 APPLE VALLEY CT
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-3640
Country	:	US
Telephone Number	:	440-262-3700
Fax Number	:	440-262-3702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/09/2007

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Directions to “ JOHN BERTSCHLER PH.D.” Practice Location

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