Provider Demographics
NPI:1447421425
Name:BRUCE A KLUNZINGER MD, PC
Entity Type:Organization
Organization Name:BRUCE A KLUNZINGER MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-372-7987
Mailing Address - Street 1:3960 PATIENT CARE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4276
Mailing Address - Country:US
Mailing Address - Phone:517-372-7987
Mailing Address - Fax:517-372-7988
Practice Address - Street 1:3960 PATIENT CARE DR STE 101
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4276
Practice Address - Country:US
Practice Address - Phone:517-372-7987
Practice Address - Fax:517-372-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036484207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2111009Medicaid
MI2111009Medicaid
MI0P56600Medicare PIN