Provider Demographics
NPI:1467423517
Name:BRUENING, BETH K (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:K
Last Name:BRUENING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 TOWER RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5098
Mailing Address - Country:US
Mailing Address - Phone:605-217-4500
Mailing Address - Fax:605-217-4503
Practice Address - Street 1:101 TOWER RD STE 300
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5098
Practice Address - Country:US
Practice Address - Phone:605-217-4500
Practice Address - Fax:605-217-4503
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3577207W00000X
NE17691207W00000X
IA28135207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025636300Medicaid
IA2072876Medicaid
SD7760323Medicaid
P00378161Medicare PIN
IA2072876Medicaid
NE10025636300Medicaid
IA5859000001Medicare NSC
SDS101616Medicare PIN