Provider Demographics
NPI:1760587331
Name:BRUNFELDT, JOAN K (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:K
Last Name:BRUNFELDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1361
Mailing Address - Country:US
Mailing Address - Phone:785-842-3635
Mailing Address - Fax:785-842-8645
Practice Address - Street 1:404 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1361
Practice Address - Country:US
Practice Address - Phone:785-842-3635
Practice Address - Fax:785-842-8645
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100197140AMedicaid
KS100197140AMedicaid
KS001293Medicare ID - Type Unspecified