Healthcare Provider Details

I. General information

NPI: 1790966331
Provider Name (Legal Business Name): ROBERT L BRUNK II DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ROBINHOOD CT
VALPARAISO IN
46385-8021
US

IV. Provider business mailing address

505 ROBINHOOD CT
VALPARAISO IN
46385-8021
US

V. Phone/Fax

Practice location:
  • Phone: 219-465-4118
  • Fax: 219-548-3067
Mailing address:
  • Phone: 219-465-4118
  • Fax: 219-548-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number02001839A
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT L BRUNK
Title or Position: OWNER
Credential: D.O.
Phone: 219-465-4118