Healthcare Provider Details

I. General information

NPI: 1285384792
Provider Name (Legal Business Name): STEPHANIE BRUNO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 250
MILWAUKEE WI
53215-3678
US

IV. Provider business mailing address

2901 W OKLAHOMA AVE
MILWAUKEE WI
53215-4329
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6732
  • Fax:
Mailing address:
  • Phone:
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9624-851
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: