Provider Demographics
NPI:1003996547
Name:GALONSKY, BRUCE WEBER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WEBER
Last Name:GALONSKY
Suffix:
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 1:363 FREMONT STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017
Mailing Address - Country:US
Mailing Address - Phone:269-969-6123
Mailing Address - Fax:269-969-6122
Practice Address - Street 1:363 FREMONT STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-969-6123
Practice Address - Fax:269-969-6122
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0131332OtherPHP
MI0101303482OtherBLUE CROSS BLUE SHIELD
MI0130348OtherBLUE CARE NETWORK
MI0130348OtherBLUE CARE NETWORK
MIP01470003Medicare ID - Type Unspecified