Provider Demographics
NPI:1033404553
Name:BRUNELLI, BIANCA STEPHANIE (DO)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:STEPHANIE
Last Name:BRUNELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 E SHEA BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4258
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:480-889-0186
Practice Address - Street 1:4611 E SHEA BLVD STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:480-889-0180
Practice Address - Fax:480-889-0186
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006605207R00000X, 208M00000X
MI5101019387207R00000X
AZ207QH0002X207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315050625OtherBOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE
AZ041428Medicaid