Provider Demographics
NPI:1174628903
Name:BRUEGGEMAN, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:BRUEGGEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 WEST FOREST, STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301
Mailing Address - Country:US
Mailing Address - Phone:731-541-9490
Mailing Address - Fax:731-541-9485
Practice Address - Street 1:700 WEST FOREST, STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-541-9490
Practice Address - Fax:731-541-9485
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN137422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0702090003OtherPALMETTO GBA DME
TN38955OtherMEMPHIS MANAGED CARE
TN4182440OtherBCBS
TN3008329Medicaid
TN130006552OtherRAILROAD MEDICARE
TN0050209OtherBCBST
TN30083261Medicare PIN
TN0050209OtherBCBST
TN130006552OtherRAILROAD MEDICARE