Basic Information
| Provider Information | |||||||||
| NPI: | 1083971683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERTKE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5053 WOOSTER RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452262326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512273 | ||||||||
| FaxNumber: | 5137511848 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 MERCY HEALTH BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452111108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 77947 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | R2872 | KY | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0001X | 35.140910 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.