Healthcare Provider Details

I. General information

NPI: 1659579712
Provider Name (Legal Business Name): EMILY A. BRUNNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 CAHILL AVE
INVER GROVE HEIGHTS MN
55076-2066
US

IV. Provider business mailing address

6775 CAHILL AVE
INVER GROVE HEIGHTS MN
55076-2066
US

V. Phone/Fax

Practice location:
  • Phone: 833-957-3761
  • Fax:
Mailing address:
  • Phone: 833-338-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number58728
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: