Provider Demographics
NPI:1043232416
Name:BRUNO, THOMAS (AA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BRUNO
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67-000063367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2474737Medicaid
OHP00412430OtherRAILROAD MEDICARE
OH0583328OtherBCMH
OH414953OtherWELLCARE MEDICAID
OH430037558OtherRAILROAD MEDICARE
OH000000232157OtherUNISON
OH000000515961OtherANTHEM
OH5421675OtherAETNA
OH430037558OtherRAILROAD MEDICARE
OHP00412430OtherRAILROAD MEDICARE
OHBR7286831Medicare ID - Type Unspecified