Provider Demographics
NPI:1356626238
Name:BRULE, ADAM T (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:T
Last Name:BRULE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2584
Mailing Address - Country:US
Mailing Address - Phone:513-974-4755
Mailing Address - Fax:
Practice Address - Street 1:630 EATON AVE
Practice Address - Street 2:2W
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2767
Practice Address - Country:US
Practice Address - Phone:513-867-2433
Practice Address - Fax:513-867-2499
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0118082084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0138465Medicaid
OHH366070Medicare PIN