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NPI Code Detail

MEDICARE: DR. MICHAEL I BRUDERLY M.D.

MEDICARE: DR. MICHAEL I BRUDERLY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301081599MI

General Provider Information

NPI Number : 1164480141
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL I BRUDERLY M.D.
Provider Business Mailing Address
First Line : 24 FRANK LLOYD WRIGHT DR
Second Line : PO BOX 0446 LOBBY J
City : ANN ARBOR
State : MI
Zip : 48105-9484
Country : US
Telephone Number : 734-747-6766
Fax Number :
Provider Business Practice Location Address
First Line : 4350 JACKSON RD
Second Line : SUITE 200
City : ANN ARBOR
State : MI
Zip : 48103-1889
Country : US
Telephone Number : 734-761-2581
Fax Number : 734-761-9540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 12/27/2016

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