Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 5101006795 | MI |
NPI | 1215955422 |
---|---|
Provider Name | Mr. Jeffrey M Bruner |
First Address | Clinton Twp, MI 48038-1653 |
Second Address | Clinton Twp, MI 48038-1653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 20/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A76757 | (02) | MI |