Provider Demographics
NPI:1376575332
Name:BRUNNER, PATRICIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:GUASTELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 CENTRAL AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2666
Mailing Address - Country:US
Mailing Address - Phone:847-256-6480
Mailing Address - Fax:847-256-6482
Practice Address - Street 1:1100 CENTRAL AVE
Practice Address - Street 2:SUITE H
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2666
Practice Address - Country:US
Practice Address - Phone:847-256-6480
Practice Address - Fax:847-256-6482
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics