Healthcare Provider Details

I. General information

NPI: 1255810529
Provider Name (Legal Business Name): MICHAEL DARRELL BRUNK B.S.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 ALBRIGHT RD
KOKOMO IN
46902-3996
US

IV. Provider business mailing address

5409 MENOMONEE DR
KOKOMO IN
46902-5445
US

V. Phone/Fax

Practice location:
  • Phone: 765-455-8545
  • Fax:
Mailing address:
  • Phone: 765-252-8639
  • Fax: 765-455-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: