Provider Demographics
NPI:1780670273
Name:BRUCK, CHRISTOPHER ERIC (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ERIC
Last Name:BRUCK
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 1:4 COLUMBUS AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6472
Mailing Address - Country:US
Mailing Address - Phone:989-892-4591
Mailing Address - Fax:989-892-7712
Practice Address - Street 1:4 COLUMBUS AVE STE 250
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6472
Practice Address - Country:US
Practice Address - Phone:989-892-4591
Practice Address - Fax:989-892-7712
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICB066451208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3168436Medicaid
OM13220Medicare ID - Type Unspecified
G11343Medicare UPIN