Healthcare Provider Details

I. General information

NPI: 1306942123
Provider Name (Legal Business Name): CHARLES LEWIS BRUEHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 BUFFALO RD SUITE 1B
NORTH CHILI NY
14514-1024
US

IV. Provider business mailing address

4415 BUFFALO RD SUITE 1B
NORTH CHILI NY
14514-1024
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-9254
  • Fax: 585-594-9233
Mailing address:
  • Phone: 585-594-9254
  • Fax: 585-594-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number188551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: