Provider Demographics
NPI:1548421266
Name:BRUNSMAN, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BRUNSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16025 N 4TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4415
Mailing Address - Country:US
Mailing Address - Phone:602-298-4688
Mailing Address - Fax:
Practice Address - Street 1:17220 N BOSWELL BLVD
Practice Address - Street 2:SUITE 225 E
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-2000
Practice Address - Country:US
Practice Address - Phone:623-876-9100
Practice Address - Fax:623-876-9300
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26483208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice