Provider Demographics
NPI:1265597223
Name:BRUNDAGE, SCOTT R (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:BRUNDAGE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2060 EAST PARIS AVENUE SE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-454-1256
Mailing Address - Fax:616-454-0308
Practice Address - Street 1:2060 EAST PARIS AVENUE SE
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-454-1256
Practice Address - Fax:616-454-0308
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2014-02-03
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Provider Licenses
StateLicense IDTaxonomies
MI045016208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A16496Medicare UPIN