MEDICARE: DR. PATRICK J BERTOLINI 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
1	207Q00000X	Family Medicine Physician	16656	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080094114	OTHER	NE	MEDICARE TRAVELERS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	06213	OTHER	NE	BCBS PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750330189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK J BERTOLINI M.D.

Provider Business Mailing Address
First Line	:	3540 VILLAGE DR
Second Line	:	SUITE 100
City	:	LINCOLN
State	:	NE
Zip	:	68516-4706
Country	:	US
Telephone Number	:	402-420-7113
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 VILLAGE DR
Second Line	:	SUITE 100
City	:	LINCOLN
State	:	NE
Zip	:	68516-4706
Country	:	US
Telephone Number	:	402-420-7113
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	05/27/2020

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