Provider Demographics
NPI:1881692697
Name:CERTO, LOUIS M (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:CERTO
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 1:304 WAINWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1900
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:224-235-8460
Practice Address - Street 1:300 CHAPEL HARBOR DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-4131
Practice Address - Country:US
Practice Address - Phone:412-356-0110
Practice Address - Fax:224-235-4652
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4596C208600000X
PAMD039604L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001132130Medicaid
PAB36554Medicare UPIN