Provider Demographics
NPI:1376570416
Name:BRUNNING, RICHARD DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DALE
Last Name:BRUNNING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 609
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-0622
Mailing Address - Fax:612-626-2696
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:420 DELAWARE STREET SE, ROOM 760 MAYO MEMORIAL BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-0622
Practice Address - Fax:612-626-2696
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN16381207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP22073OtherHEALTHPARTNERS
MN2T206BROtherBCBS
MN11-74536OtherMEDICA PRIMARY
MN1008997OtherPREFERRED ONE
MN101348OtherUCARE
MN11-22540OtherMEDICA CHOICE
MN768042OtherARAZ
MNHP22073OtherHEALTHPARTNERS