Provider Demographics
NPI:1710981469
Name:BRUNER, CRAIG MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:MATTHEW
Last Name:BRUNER
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 1:5800 FOXRIDGE DR
Mailing Address - Street 2:STE 240
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2338
Mailing Address - Country:US
Mailing Address - Phone:913-261-3153
Mailing Address - Fax:913-262-3295
Practice Address - Street 1:5800 FOXRIDGE DR
Practice Address - Street 2:STE 240
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2338
Practice Address - Country:US
Practice Address - Phone:913-261-3153
Practice Address - Fax:913-262-3295
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-276312085R0202X
MO20001720822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100381650BMedicaid
KS100381650AMedicaid
MO205166101Medicaid
MOJ96A857Medicare PIN
KS100381650AMedicaid
KSJ96A857AMedicare PIN
MO205166101Medicaid