Basic Information
| Provider Information | |||||||||
| NPI: | 1306965983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUDREY BRUELL, M.D. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37605 PEMBROKE | ||||||||
| Address2: | JAMES JAMES TOWNE | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481521050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345917931 | ||||||||
| FaxNumber: | 7344640335 | ||||||||
| Practice Location | |||||||||
| Address1: | 37605 PEMBROKE AVE | ||||||||
| Address2: | JAMES JAMES TOWNE | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481521050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345917931 | ||||||||
| FaxNumber: | 7344640335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 04/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | MAYER | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9896664775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 4301062941 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.