Basic Information
| Provider Information | |||||||||
| NPI: | 1003996547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALONSKY | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | WEBER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 FREMONT STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699696123 | ||||||||
| FaxNumber: | 2699696122 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 FREMONT STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699696123 | ||||||||
| FaxNumber: | 2699696122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301068317 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0131332 | 01 | MI | PHP | OTHER | 0101303482 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 0130348 | 01 | MI | BLUE CARE NETWORK | OTHER |