Provider Demographics
NPI:1790966331
Name:ROBERT L BRUNK II DO PC
Entity Type:Organization
Organization Name:ROBERT L BRUNK II DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-465-4118
Mailing Address - Street 1:505 ROBINHOOD CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8021
Mailing Address - Country:US
Mailing Address - Phone:219-465-4118
Mailing Address - Fax:219-548-3067
Practice Address - Street 1:505 ROBINHOOD CT
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8021
Practice Address - Country:US
Practice Address - Phone:219-465-4118
Practice Address - Fax:219-548-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001839A261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN229660Medicare PIN