Provider Demographics
NPI:1588871388
Name:BERTOGLIO, BRYAN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ANDREW
Last Name:BERTOGLIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:EBERLE SUITE 610
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3630
Mailing Address - Fax:847-981-3633
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:EBERLE SUITE 610
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3630
Practice Address - Fax:847-981-3633
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-6882207T00000X
IL0361123998207T00000X
IA37924207T00000X
IL036123998207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923084Medicare PIN