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NPI Code Detail

MEDICARE: DR. TERESA DENISE BERTSCH M.D.

MEDICARE: DR. TERESA DENISE BERTSCH 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
12084P0800XPsychiatry Physician20886AZ

Other Identifiers

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

General Provider Information

NPI Number : 1639179369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESA DENISE BERTSCH M.D.
Provider Business Mailing Address
First Line : PO BOX 3630
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86003-3630
Country : US
Telephone Number : 928-522-9879
Fax Number : 928-522-9880
Provider Business Practice Location Address
First Line : 2920 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-1816
Country : US
Telephone Number : 928-522-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 05/28/2020

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