Healthcare Provider Details

I. General information

NPI: 1164454120
Provider Name (Legal Business Name): MICHAEL F BRUNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE 217 MEDICAL ARTS PAVILION ONE
NEWARK DE
19713-2067
US

IV. Provider business mailing address

56 ELWOOD DR
SMYRNA DE
19977-4800
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-2374
  • Fax: 302-733-2602
Mailing address:
  • Phone: 302-242-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1 0006904
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: