Provider Demographics
NPI:1205042249
Name:CLEEREMANS, BRUCE BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BRADLEY
Last Name:CLEEREMANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16405 SAND CANYON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3787
Mailing Address - Country:US
Mailing Address - Phone:949-753-1882
Mailing Address - Fax:949-727-3365
Practice Address - Street 1:16405 SAND CANYON AVE STE 220
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3787
Practice Address - Country:US
Practice Address - Phone:949-753-1882
Practice Address - Fax:949-727-3365
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0469382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50547Medicare UPIN
CAG046938Medicare ID - Type UnspecifiedSTATE LICENSE