Basic Information
| Provider Information | |||||||||
| NPI: | 1164612495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUKETE | ||||||||
| FirstName: | BERTRAND | ||||||||
| MiddleName: | NJUME | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 S 2ND ST STE 2F | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176371738 | ||||||||
| FaxNumber: | 7176467430 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 STOCK ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176371738 | ||||||||
| FaxNumber: | 7176467430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 53880 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207UN0901X | MD467014 | PA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | MD467014 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 53880 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 103639194 | 05 | PA | MEDICAID |