MEDICARE: DR. MARY E BERTRAND 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	2084E0001X	Epilepsy Physician	103319	MO
2	2084N0400X	Neurology Physician	103319	MO

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

General Provider Information

NPI Number	:	1740211986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E BERTRAND MD

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-454-6120
Fax Number	:	314-454-4225

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PL
Second Line	:	DIV NEUROLOGY PEDIATRICS, STE 2130
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-6120
Fax Number	:	314-454-4225

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/15/2025

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Directions to “ DR. MARY E BERTRAND MD” Practice Location

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