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NPI Code Detail

MEDICARE: KATHERINE A BERTRAM M.D.

MEDICARE: KATHERINE A BERTRAM 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
1207R00000XInternal Medicine Physician20230TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689668790
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE A BERTRAM M.D.
Provider Business Mailing Address
First Line : 128 N WHITNEY AVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-2493
Country : US
Telephone Number : 931-783-5999
Fax Number : 931-783-5898
Provider Business Practice Location Address
First Line : 128 N WHITNEY AVE
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-2493
Country : US
Telephone Number : 931-783-4600
Fax Number : 931-783-4699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2005
Last Update Date : 06/29/2020

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Directions to “ KATHERINE A BERTRAM M.D.” Practice Location

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