Provider Demographics
NPI:1083657555
Name:BERTLER, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:BERTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1400 SCHEURING RD
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1067
Practice Address - Country:US
Practice Address - Phone:920-683-5278
Practice Address - Fax:920-683-2131
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29339020207N00000X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI29339-020OtherSTATE LICENSE
WI382000019OtherMEDICARE
WI32318400Medicaid
WIP00218264OtherRAILROAD MEDICARE
WIP00218264OtherRAILROAD MEDICARE
WI000417140Medicare ID - Type Unspecified
WIBB4957239OtherDEA