Healthcare Provider Details

I. General information

NPI: 1184678765
Provider Name (Legal Business Name): ROBERT L BRUNK II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LAPORTE AVE SUITE 102
VALPARAISO IN
46383-5860
US

IV. Provider business mailing address

2264 U. S. HWY 30 SUITE 111
VALPARAISO IN
46385
US

V. Phone/Fax

Practice location:
  • Phone: 219-477-5242
  • Fax: 219-477-4859
Mailing address:
  • Phone: 219-477-5242
  • Fax: 219-477-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02001839A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: