MEDICARE: MR. MARIO E. BERTONI M.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	2085R0202X	Diagnostic Radiology Physician	E5682	TX
2	208D00000X	General Practice Physician	E5682	TX

General Provider Information

NPI Number	:	1447264437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO E. BERTONI M.D.

Provider Business Mailing Address
First Line	:	6550 MAPLERIDGE ST STE 216
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4648
Country	:	US
Telephone Number	:	832-830-8997
Fax Number	:	281-888-3918

Provider Business Practice Location Address
First Line	:	6550 MAPLERIDGE ST STE 216
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4648
Country	:	US
Telephone Number	:	832-830-8997
Fax Number	:	281-888-3918

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	03/25/2010

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