Provider Demographics
NPI:1265436836
Name:BRUINS, GEORGE S (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:BRUINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4600 BRETON RD SE
Mailing Address - Street 2:STE 102
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5220
Mailing Address - Country:US
Mailing Address - Phone:616-391-9700
Mailing Address - Fax:616-391-9707
Practice Address - Street 1:4600 BRETON RD SE
Practice Address - Street 2:STE 102
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5220
Practice Address - Country:US
Practice Address - Phone:616-391-9700
Practice Address - Fax:616-391-9707
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301057804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3149083Medicaid
MI3149083Medicaid
MIOD16321009Medicare ID - Type Unspecified