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General NPI Number Information
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NPI Number | 1215166319
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Entity Type | Individual
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Provider Name | MICHAEL BRUNNER DO
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 1041 W STEARNS RD
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City | BARTLETT
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State | IL
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Zip | 60103-4509
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Country | US
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Telephone | 630-716-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 E LAKE ST ATTN: ABMG PRIMARY CARE
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City | HANOVER PARK
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State | IL
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Zip | 60133-4869
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Country | US
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Telephone | 630-483-3200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.133928
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125055948
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License Number State | IL
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