Healthcare Provider Details

I. General information

NPI: 1841403912
Provider Name (Legal Business Name): ROBERT BRULEY MD, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 W 43RD ST
MINNEAPOLIS MN
55410-1536
US

IV. Provider business mailing address

4142 YORK AVE S
MINNEAPOLIS MN
55410-1152
US

V. Phone/Fax

Practice location:
  • Phone: 612-455-0444
  • Fax: 612-455-0600
Mailing address:
  • Phone: 612-922-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number23723
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: