Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 63540 | MN |
NPI | 1053765982 |
---|---|
Provider Name | Paul Bruhnding |
First Address | Green Bay, WI 54311-6213 |
Second Address | Green Bay, WI 54311-6213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2016 |
Last Update Date | 02/08/2021 |