Basic Information
| Provider Information | |||||||||
| NPI: | 1346453396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOSEPH A. BRUNO MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6010 GULL ROAD | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490489452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693854671 | ||||||||
| FaxNumber: | 2693852657 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 GULL RD | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490489452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693854671 | ||||||||
| FaxNumber: | 2693852657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 05/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | ANGLIN | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2693854671 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | JB033841 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2674024 | 05 | MI | MEDICAID |