Provider Demographics
NPI:1336156421
Name:BRUCE B CLEEREMANS MD A PROF CORP
Entity Type:Organization
Organization Name:BRUCE B CLEEREMANS MD A PROF CORP
Other - Org Name:NERVE PRO MEDICAL CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:CLEEREMANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9497-853-1882
Mailing Address - Street 1:15825 LAGUNA CANYON RD
Mailing Address - Street 2:STE 202
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2127
Mailing Address - Country:US
Mailing Address - Phone:949-753-1882
Mailing Address - Fax:949-727-3365
Practice Address - Street 1:15825 LAGUNA CANYON RD
Practice Address - Street 2:STE 202
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2127
Practice Address - Country:US
Practice Address - Phone:949-753-1882
Practice Address - Fax:949-727-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0469382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A50547Medicare UPIN
CAG046938Medicare ID - Type Unspecified