Provider Demographics
NPI:1619063930
Name:BRUNCK, BRIAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:BRUNCK
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:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0530
Mailing Address - Country:US
Mailing Address - Phone:765-521-1217
Mailing Address - Fax:765-599-3286
Practice Address - Street 1:1000 N 16TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1217
Practice Address - Fax:765-599-3286
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037495208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100135140Medicaid
IN220890AMedicare ID - Type Unspecified
E14962Medicare UPIN