Provider Demographics
NPI:1497833784
Name:BRUHL, MELISSA (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BRUHL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5484
Mailing Address - Country:US
Mailing Address - Phone:641-753-4518
Mailing Address - Fax:641-753-4203
Practice Address - Street 1:1301 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5484
Practice Address - Country:US
Practice Address - Phone:641-753-4518
Practice Address - Fax:641-753-4203
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3333207R00000X
AZ008657207R00000X
CODR.0064788207R00000X
KS05-43865207R00000X
KY04726207R00000X
MI5101025782207R00000X
NVDO2770207R00000X
NY305438207R00000X
OH34.014683207R00000X
RIDO01042207R00000X
TN3917207R00000X
WAOP61076411207R00000X
IAR00398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAH34255Medicare UPIN