Provider Demographics
NPI:1255810529
Name:BRUNK, MICHAEL DARRELL (BSED)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DARRELL
Last Name:BRUNK
Suffix:
Gender:M
Credentials:BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 MENOMONEE DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-5445
Mailing Address - Country:US
Mailing Address - Phone:765-252-8639
Mailing Address - Fax:765-455-8552
Practice Address - Street 1:2739 ALBRIGHT RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3996
Practice Address - Country:US
Practice Address - Phone:765-455-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator