Provider Demographics
NPI:1891006235
Name:BERTELLE-SEMMA, MICHELE LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LYNN
Last Name:BERTELLE-SEMMA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 GOSHEN DR
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-5003
Mailing Address - Country:US
Mailing Address - Phone:786-514-9493
Mailing Address - Fax:786-364-1580
Practice Address - Street 1:1001 WELCH RD
Practice Address - Street 2:SUITE #10
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-2864
Practice Address - Country:US
Practice Address - Phone:786-514-9493
Practice Address - Fax:786-364-1580
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3527213E00000X, 213ES0103X
MI5901002578213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery