Provider Demographics
NPI:1184814188
Name:BRUNER, MICHELLE K (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:BRUNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4238 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2231
Practice Address - Country:US
Practice Address - Phone:813-879-6040
Practice Address - Fax:813-879-6043
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2025-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS16266207N00000X
MI5101017195207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45390006Medicare PIN