Provider Demographics
NPI:1225018591
Name:DALL, BRUCE E (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:DALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1541 GULL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1639
Mailing Address - Country:US
Mailing Address - Phone:269-343-1264
Mailing Address - Fax:269-343-9555
Practice Address - Street 1:1541 GULL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1639
Practice Address - Country:US
Practice Address - Phone:269-343-1264
Practice Address - Fax:269-343-9555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301042369207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4716750Medicaid
MI4716750Medicaid
MIP02200002Medicare ID - Type Unspecified