Provider Demographics
NPI:1619901956
Name:JEFFREY M. BRUNER, D.O., P.C.
Entity Type:Organization
Organization Name:JEFFREY M. BRUNER, D.O., P.C.
Other - Org Name:ASTHMA & ALLERGY INSTITUTE OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-286-9010
Mailing Address - Street 1:42607 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1653
Mailing Address - Country:US
Mailing Address - Phone:586-286-9010
Mailing Address - Fax:586-286-7910
Practice Address - Street 1:42607 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1653
Practice Address - Country:US
Practice Address - Phone:586-286-9010
Practice Address - Fax:586-286-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207K00000X
MIAI406807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76757Medicare UPIN
F63498Medicare UPIN
MI0E045752701Medicare ID - Type Unspecified
MI0E04575Medicare ID - Type Unspecified