Provider Demographics
NPI:1881646479
Name:WILLMAN, BERTRAM (MD)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:
Last Name:WILLMAN
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:DEPT # 1029
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80263-0001
Mailing Address - Country:US
Mailing Address - Phone:352-867-8898
Mailing Address - Fax:352-732-6282
Practice Address - Street 1:3030 N CIRCLE DR
Practice Address - Street 2:STE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1180
Practice Address - Country:US
Practice Address - Phone:719-228-9440
Practice Address - Fax:719-228-9061
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COME35802207L00000X
CODR.0035802207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO001358027Medicaid
COD4558OtherANTHEM/BLUE CROSS
COD4558OtherRAILROAD MEDICARE
CO001358027Medicaid
COCD4558Medicare PIN