Provider Demographics
NPI:1992006886
Name:BRUNNABEND, MICHELLE LYNN (MPH, DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:BRUNNABEND
Suffix:
Gender:F
Credentials:MPH, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 N MERIDIAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8316
Mailing Address - Country:US
Mailing Address - Phone:405-254-1757
Mailing Address - Fax:405-254-1758
Practice Address - Street 1:13313 N MERIDIAN AVE STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-254-1757
Practice Address - Fax:405-254-1758
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11406207V00000X
OK5528207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200544490AMedicaid
OK359408ZHV4Medicare PIN