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1609865823

NPI Code Detail

MEDICARE: KENNETH R. BERTKA MD

MEDICARE: KENNETH R. BERTKA 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	207Q00000X	Family Medicine Physician	35050904	OH
2	207Q00000X	Family Medicine Physician	65395	WI
3	207Q00000X	Family Medicine Physician	MD460346	PA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609865823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH R. BERTKA MD

Provider Business Mailing Address
First Line	:	2830 EASTON AVE
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-4204
Country	:	US
Telephone Number	:	484-526-3555
Fax Number	:	484-526-3560

Provider Business Practice Location Address
First Line	:	2830 EASTON AVE
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-4204
Country	:	US
Telephone Number	:	484-526-3555
Fax Number	:	484-526-3560

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	05/04/2017

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Directions to “ KENNETH R. BERTKA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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