Healthcare Provider Details

I. General information

NPI: 1013228907
Provider Name (Legal Business Name): TIMOTHY PETER BRUCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 N PORT WASHINGTON RD
GLENDALE WI
53217-4524
US

IV. Provider business mailing address

N4W22370 BLUEMOUND RD
WAUKESHA WI
53186-1683
US

V. Phone/Fax

Practice location:
  • Phone: 414-439-3000
  • Fax:
Mailing address:
  • Phone: 414-439-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number01070075A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number125.068486
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number80034-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: