Provider Demographics
NPI:1710393657
Name:DR.CONSTANTINE BRUNS PC
Entity Type:Organization
Organization Name:DR.CONSTANTINE BRUNS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:847-410-2029
Mailing Address - Street 1:8170 MCCORMICK BLVD
Mailing Address - Street 2:SUITE NO.204
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-410-2029
Mailing Address - Fax:847-410-2041
Practice Address - Street 1:8170 MCCORMICK BLVD
Practice Address - Street 2:SUITE NO.204
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2961
Practice Address - Country:US
Practice Address - Phone:847-410-2029
Practice Address - Fax:847-410-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002733103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty