Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 35096568 | OH |
N | 207V00000X | Obstetrician & Gynecologist | 35.096568 | OH |
NPI | 1639170509 |
---|---|
Provider Name | Patrick Bruno |
First Address | Shaker Heights, OH 44120-5122 |
Second Address | Shaker Heights, OH 44120-5122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 20/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34165000 | (05) | WI |
F56095 | (02) | WI |