Provider Demographics
NPI:1538340252
Name:DR V PAUL BERTRAND NEUROLOGY & NE URODIAGNOSTICS LTD
Entity type:Organization
Organization Name:DR V PAUL BERTRAND NEUROLOGY & NE URODIAGNOSTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VOLKER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-469-2888
Mailing Address - Street 1:655 N LAGRANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-469-2888
Mailing Address - Fax:815-469-3697
Practice Address - Street 1:655 N LAGRANGE ROAD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:815-469-2888
Practice Address - Fax:815-469-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360592452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC25499Medicare UPIN