Provider Demographics
NPI:1831418078
Name:BRUENE, JULIA ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ROSE
Last Name:BRUENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 W HARRISON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-432-2440
Mailing Address - Fax:708-409-5179
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-432-2440
Practice Address - Fax:708-409-5179
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058044207Q00000X
IL036131892207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine