Provider Demographics
NPI:1558681577
Name:BERTUMEN, J. BRADFORD HAMPSHIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:J. BRADFORD
Middle Name:HAMPSHIRE
Last Name:BERTUMEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:STE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0871
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-734-4715
Practice Address - Street 1:13755 CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-1824
Practice Address - Country:US
Practice Address - Phone:708-385-2400
Practice Address - Fax:708-385-2434
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2017-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036141514207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036141514Medicaid
IL036141514Medicaid
ILF400322124Medicare PIN