Provider Demographics
NPI:1073709481
Name:ROLF BRUNCKHORST MD INC
Entity Type:Organization
Organization Name:ROLF BRUNCKHORST MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNCKHORST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-523-1844
Mailing Address - Street 1:5241 MORNING SUN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8928
Mailing Address - Country:US
Mailing Address - Phone:513-523-1844
Mailing Address - Fax:
Practice Address - Street 1:5241 MORNING SUN RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-8928
Practice Address - Country:US
Practice Address - Phone:513-523-1844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty