Provider Demographics
NPI:1952334609
Name:EDDY S. BRUNO, M.D., LLC
Entity type:Organization
Organization Name:EDDY S. BRUNO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:SEVERE
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-225-8808
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0217
Mailing Address - Country:US
Mailing Address - Phone:419-225-8808
Mailing Address - Fax:419-222-7220
Practice Address - Street 1:920 W MARKET ST STE 310
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2777
Practice Address - Country:US
Practice Address - Phone:419-225-8808
Practice Address - Fax:419-222-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350826302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2582709Medicaid
OHBR4131635Medicare ID - Type Unspecified
OH2582709Medicaid