Provider Demographics
NPI:1215042601
Name:BRUNT, JOYCE KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:KAREN
Last Name:BRUNT
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 1:408 GINGERBEND DR.
Mailing Address - Street 2:APT . 102
Mailing Address - City:CHAMPAIGN
Mailing Address - State:PA
Mailing Address - Zip Code:61822
Mailing Address - Country:US
Mailing Address - Phone:217-351-5871
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH76751Medicare UPIN