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NPI Code Detail

MEDICARE: S. LUKE BERTHELSEN DPM, INC

MEDICARE: S. LUKE BERTHELSEN DPM, INC
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
1213ES0103XFoot & Ankle Surgery PodiatristE5190CA

General Provider Information

NPI Number : 1821598004
Entity Type Code : Organization
Provider Name (Legal Business Name) : S. LUKE BERTHELSEN DPM, INC
Provider Business Mailing Address
First Line : 2067 W VISTA WAY STE 265
Second Line :
City : VISTA
State : CA
Zip : 92083-6034
Country : US
Telephone Number : 760-463-9155
Fax Number : 760-712-4212
Provider Business Practice Location Address
First Line : 2067 W VISTA WAY STE 265
Second Line :
City : VISTA
State : CA
Zip : 92083-6034
Country : US
Telephone Number : 760-463-9155
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. STEVEN LUKE BERTHELSEN
Credential : DPM
Telephone Number : 760-463-9155
Provider Enumeration Date : 02/14/2018
Last Update Date : 10/25/2018

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Directions to “S. LUKE BERTHELSEN DPM, INC ” Practice Location

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