Provider Demographics
NPI:1497052468
Name:BRUCE, DINA (DO)
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:KAZATSKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2629 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4932
Mailing Address - Country:US
Mailing Address - Phone:515-707-2590
Mailing Address - Fax:
Practice Address - Street 1:2629 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4932
Practice Address - Country:US
Practice Address - Phone:515-707-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63978-21207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine