Provider Demographics
NPI:1407950116
Name:BERTOLINI, JERRY E (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:E
Last Name:BERTOLINI
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 1:202 N HAMMES
Mailing Address - Street 2:SUITE D
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8136
Mailing Address - Country:US
Mailing Address - Phone:815-741-4104
Mailing Address - Fax:815-741-4135
Practice Address - Street 1:202 N HAMMES
Practice Address - Street 2:SUITE D
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8136
Practice Address - Country:US
Practice Address - Phone:815-741-4104
Practice Address - Fax:815-741-4135
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057862207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057862Medicaid
IL036057862Medicaid
C45683Medicare UPIN