Provider Demographics
NPI:1841403912
Name:BRULEY, ROBERT (MD, DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BRULEY
Suffix:
Gender:M
Credentials:MD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 YORK AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1152
Mailing Address - Country:US
Mailing Address - Phone:612-922-5733
Mailing Address - Fax:
Practice Address - Street 1:2826 W 43RD ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1536
Practice Address - Country:US
Practice Address - Phone:612-455-0444
Practice Address - Fax:612-455-0600
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23723207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE42549Medicare UPIN