Most Relevant Information
Provider Data
| NPI Number: | 1003400383 |
| Provider Name: | TIMOTHY D BERTRAM |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/26/2021 |
| Last Updated: | 02/26/2021 |
Provider Practice Location
1173 S PACKARD AVE
BURTON
MI
485092311
Practice Location Phone/Fax
| Phone: | 8103485923 |
| Fax: | 8104621093 |
Provider Mailing Location
1173 S PACKARD AVE
BURTON
MI
485092311
Provider Mailing Phone/Fax
| Phone: | 8103485923 |
| Fax: | 8104621093 |