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NPI Code Detail

MEDICARE: SUSAN M BRUNDAGE LLP

MEDICARE: SUSAN M BRUNDAGE LLP
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
1103T00000XPsychologist6301010897MI

General Provider Information

NPI Number : 1861531410
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M BRUNDAGE LLP
Provider Business Mailing Address
First Line : PO BOX 2588
Second Line :
City : PORTAGE
State : MI
Zip : 49081-2588
Country : US
Telephone Number : 269-373-8878
Fax Number : 269-373-4720
Provider Business Practice Location Address
First Line : 694 W CHICAGO RD
Second Line :
City : COLDWATER
State : MI
Zip : 49036-8405
Country : US
Telephone Number : 517-279-8866
Fax Number : 517-279-8866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2007

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Directions to “ SUSAN M BRUNDAGE LLP” Practice Location

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