Provider Demographics
NPI:1598730459
Name:BRUNS, ERIC CARL (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CARL
Last Name:BRUNS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E GENEVA SQ
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-9694
Mailing Address - Country:US
Mailing Address - Phone:262-248-9565
Mailing Address - Fax:262-248-0065
Practice Address - Street 1:160 E GENEVA SQ
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-9694
Practice Address - Country:US
Practice Address - Phone:262-248-9565
Practice Address - Fax:262-248-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI648-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43215500Medicaid
WI5597320001Medicare NSC
WI000165265Medicare PIN
WIU08237Medicare UPIN