Provider Demographics
NPI:1124021662
Name:BRUNE, WILLIAM G (MSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:BRUNE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 N GLENDALE DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-8909
Mailing Address - Country:US
Mailing Address - Phone:260-432-5181
Mailing Address - Fax:260-432-5692
Practice Address - Street 1:2410 N GLENDALE DR STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-8909
Practice Address - Country:US
Practice Address - Phone:260-432-5181
Practice Address - Fax:260-432-5692
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004553A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000175090OtherANTHEM BCBS
IN049915POtherSIHO
IN15126OtherPHP
IN665610GMedicare ID - Type UnspecifiedIN MEDICARE