Provider Demographics
NPI:1235102062
Name:BRUCKEN, DARREN C (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:C
Last Name:BRUCKEN
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 1:721 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2420
Mailing Address - Country:US
Mailing Address - Phone:217-465-4141
Mailing Address - Fax:217-465-5615
Practice Address - Street 1:721 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2460
Practice Address - Country:US
Practice Address - Phone:217-465-4141
Practice Address - Fax:812-299-3263
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036159332208M00000X
IN01049016A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00258235OtherRAILROAD MEDICARE
IN200211110Medicaid
IN147180QQMedicare ID - Type Unspecified
IN200211110Medicaid