Provider Demographics
NPI:1407353998
Name:BRUNING, NICHOLAS GARBER (DPM)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GARBER
Last Name:BRUNING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-7064
Mailing Address - Country:US
Mailing Address - Phone:231-779-3668
Mailing Address - Fax:734-655-2911
Practice Address - Street 1:8805 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-7064
Practice Address - Country:US
Practice Address - Phone:231-779-3668
Practice Address - Fax:734-655-2911
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5951001100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program