Healthcare Provider Details

I. General information

NPI: 1881934685
Provider Name (Legal Business Name): CHRISTOPHER E BRUCK, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COLUMBUS AVE STE 250
BAY CITY MI
48708-6472
US

IV. Provider business mailing address

4 COLUMBUS AVE STE 250
BAY CITY MI
48708-6472
US

V. Phone/Fax

Practice location:
  • Phone: 989-892-4591
  • Fax: 989-892-7712
Mailing address:
  • Phone: 989-892-4591
  • Fax: 989-892-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER E BRUCK
Title or Position: OWNER
Credential: MD
Phone: 989-892-4591