Basic Information
| Provider Information | |||||||||
| NPI: | 1619977659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUMMER | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 MARTIN LUTHER KING JR. WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092417195 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 EAST BLVD | ||||||||
| Address2: | |||||||||
| City: | ELKHART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465142483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745233160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 03/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD60309654 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01039344 | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100103240 | 05 | IN | MEDICAID | 102764201 | 05 | MI | MEDICAID | 110050650 | 01 | IN | RAIL RAOD MEDICARE | OTHER | 000000082210 | 01 | IN | ANTHEM | OTHER |