Basic Information
| Provider Information | |||||||||
| NPI: | 1487658746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6010 GULL RD | ||||||||
| 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: | 06/02/2005 | ||||||||
| LastUpdateDate: | 06/15/2009 | ||||||||
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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 | 4301033841 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2674024 | 05 | MI | MEDICAID | 1487658746 | 05 | MI | MEDICAID |