Provider Demographics
NPI:1184678765
Name:BRUNK, ROBERT L II (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:BRUNK
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2264 U. S. HWY 30
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385
Mailing Address - Country:US
Mailing Address - Phone:219-477-5242
Mailing Address - Fax:219-477-4859
Practice Address - Street 1:802 LAPORTE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5860
Practice Address - Country:US
Practice Address - Phone:219-477-5242
Practice Address - Fax:219-477-4859
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02001839A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02001839AOtherINDIANA LICENSE
IN02001839BOtherCSR
AB1404968OtherDEA
B18072Medicare UPIN
AB1404968OtherDEA