Provider Demographics
NPI:1609081355
Name:BRONN, DONALD G (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:BRONN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48303-0220
Mailing Address - Country:US
Mailing Address - Phone:248-646-7100
Mailing Address - Fax:248-646-7183
Practice Address - Street 1:1202 WALTON BLVD
Practice Address - Street 2:SUITE #211
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6917
Practice Address - Country:US
Practice Address - Phone:248-646-7100
Practice Address - Fax:888-885-8801
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010494362085R0001X
OH0507702085R0001X
FLME750842085R0001X
NY2616712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301049436OtherSTATE LICENSE
NY261671OtherSTATE LICENSE
FLME75084OtherSTATE LICENSE
OH050770OtherSTATE LICENSE
MIB48698Medicare UPIN