MEDICARE: KIM C BERTIN MD

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	164111-1205	UT

General Provider Information

NPI Number	:	1568456242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM C BERTIN MD

Provider Business Mailing Address
First Line	:	24 S 1100 E
Second Line	:	STE 101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1500
Country	:	US
Telephone Number	:	801-355-6468
Fax Number	:	801-355-3450

Provider Business Practice Location Address
First Line	:	24 S 1100 E
Second Line	:	STE 101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1500
Country	:	US
Telephone Number	:	801-355-6468
Fax Number	:	801-355-3450

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/12/2011

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Directions to “ KIM C BERTIN MD” Practice Location

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