Individual
MARK W BERTAGNOLI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-8360
Mailing address
PO BOX 1446, GREEN BAY, WI 54305-1446
(920) 983-9401
(920) 983-9402
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
40649-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32539200
—
WI
05
—
4094435
—
MI
Enumeration date
01/29/2006
Last updated
07/08/2007
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