Individual
SPENCER THOMAS BERTRAM
Active
Individual
SPENCER THOMAS BERTRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Q5156
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
4301085355
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01005987
HEALTH PLUS
MI
01
—
1023407
MCLAREN HEALTH PLAN
MI
01
—
1338919
AETNA
—
01
—
156785
GREAT LAKES HEALTH PLAN
MI
05
—
4922435-10
—
MI
01
—
502512712
BCBSM
MI
01
—
P00379788
RAILROAD MEDICARE
—
Enumeration date
06/07/2006
Last updated
01/05/2022
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