Provider Demographics
NPI:1659373629
Name:BORTEL, DAVID T (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:BORTEL
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 1:555 W WACKERLY ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4710
Mailing Address - Country:US
Mailing Address - Phone:989-631-0512
Mailing Address - Fax:989-631-7337
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4710
Practice Address - Country:US
Practice Address - Phone:989-631-0512
Practice Address - Fax:989-631-7337
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-12-02
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-05-05
Provider Licenses
StateLicense IDTaxonomies
MIDB406272207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3377857Medicaid
MI0560102OtherBCBS OF MICHIGAN
MI0560102OtherBCBS OF MICHIGAN
MIF89879Medicare UPIN