Provider Demographics
NPI:1972558518
Name:BERTOCCHI, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:BERTOCCHI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9399 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8506
Mailing Address - Country:US
Mailing Address - Phone:303-805-1855
Mailing Address - Fax:303-805-4421
Practice Address - Street 1:9399 CROWN CREST BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8506
Practice Address - Country:US
Practice Address - Phone:303-805-1855
Practice Address - Fax:303-805-4421
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO45175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18081517Medicaid
CO64475565Medicaid
COC524078Medicare PIN
CO64475565Medicaid