Provider Demographics
NPI:1982770707
Name:BRUNO, CHRISTINE J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:HELEN
Other - Last Name:JANES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:770-801-2526
Mailing Address - Fax:678-244-8207
Practice Address - Street 1:85 E US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-8947
Practice Address - Country:US
Practice Address - Phone:219-364-3616
Practice Address - Fax:219-364-3610
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079083A207RG0100X
OH35.143422207RG0100X
WI67702207RG0100X
FLME136825207RG0100X
GA038700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E99262Medicare UPIN
10BDHHVMedicare ID - Type Unspecified