Provider Demographics
NPI:1134102726
Name:BRUEMMER, VALERIE SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:SUSAN
Last Name:BRUEMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 N LEBANON ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052
Mailing Address - Country:US
Mailing Address - Phone:765-485-8855
Mailing Address - Fax:765-485-8850
Practice Address - Street 1:2705 N LEBANON ST
Practice Address - Street 2:SUITE 315
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052
Practice Address - Country:US
Practice Address - Phone:765-485-8855
Practice Address - Fax:765-485-8850
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042966A207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100468100Medicaid
IN182790QMedicare PIN
F57348Medicare UPIN