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NPI Code Detail

MEDICARE: MICHELLE K BRUNER DO

MEDICARE: MICHELLE K BRUNER DO
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
1207N00000XDermatology PhysicianOS16266FL
2207N00000XDermatology Physician5101017195MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184814188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE K BRUNER DO
Provider Business Mailing Address
First Line : 1306 CONCOURSE DR STE 201
Second Line :
City : LINTHICUM HEIGHTS
State : MD
Zip : 21090-1033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4238 W KENNEDY BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33609-2231
Country : US
Telephone Number : 813-879-6040
Fax Number : 813-879-6043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 04/11/2025

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