Provider Demographics
NPI:1346453396
Name:JOSEPH A. BRUNO MD, PC
Entity Type:Organization
Organization Name:JOSEPH A. BRUNO MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-385-4671
Mailing Address - Street 1:6010 GULL ROAD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-9452
Mailing Address - Country:US
Mailing Address - Phone:269-385-4671
Mailing Address - Fax:269-385-2657
Practice Address - Street 1:6010 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-9452
Practice Address - Country:US
Practice Address - Phone:269-385-4671
Practice Address - Fax:269-385-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB033841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2674024Medicaid
MID91288Medicare UPIN
MIC96098002Medicare PIN