Provider Demographics
NPI:1962480798
Name:BRUK, ARON (MD)
Entity Type:Individual
Prefix:DR
First Name:ARON
Middle Name:
Last Name:BRUK
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-0126
Mailing Address - Country:US
Mailing Address - Phone:618-939-8190
Mailing Address - Fax:618-939-3990
Practice Address - Street 1:224 BRADFORD LN
Practice Address - Street 2:SUITE A
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3267
Practice Address - Country:US
Practice Address - Phone:618-939-8190
Practice Address - Fax:618-939-3990
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL760550Medicare ID - Type Unspecified
ILD16247Medicare UPIN