Healthcare Provider Details

I. General information

NPI: 1639170509
Provider Name (Legal Business Name): PATRICK BRUNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 S A ST
RICHMOND IN
47374-6049
US

IV. Provider business mailing address

3535 LEE RD
SHAKER HEIGHTS OH
44120-5122
US

V. Phone/Fax

Practice location:
  • Phone: 765-962-8843
  • Fax:
Mailing address:
  • Phone: 216-417-6166
  • Fax: 216-417-8676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.096568
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35096568
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: