Provider Demographics
NPI:1942282959
Name:BRUNO, MICHAEL DOMINIC (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOMINIC
Last Name:BRUNO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:3231 MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6607
Practice Address - Country:US
Practice Address - Phone:727-725-6526
Practice Address - Fax:727-266-4931
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8297207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01012142OtherMEDICARE RAILROAD PROVIDER NUMBER
FL265527600Medicaid
FLE5794YMedicare PIN
FLP01012142OtherMEDICARE RAILROAD PROVIDER NUMBER
FLH41711Medicare UPIN