Provider Demographics
NPI:1992721898
Name:BERTENSHAW, RICHARD H JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:BERTENSHAW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 WILTON RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-6702
Mailing Address - Country:US
Mailing Address - Phone:708-921-6053
Mailing Address - Fax:877-992-6901
Practice Address - Street 1:7545 WILTON RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-6702
Practice Address - Country:US
Practice Address - Phone:708-921-6053
Practice Address - Fax:877-992-6901
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074851207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1609994987OtherGROUP PRACTICE NPI
ILC30167OtherRAILROAD MEDICARE PTAN
IL1609994987OtherGROUP PRACTICE NPI
ILC30167OtherRAILROAD MEDICARE PTAN