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General NPI Number Information
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NPI Number | 1326741430
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Entity Type | Organization
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Legal Business Name | RUSSEL BRUBAKER MD
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 11751 RURAL ACRES DR SE
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City | ALTO
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State | MI
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Zip | 49302-9577
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Country | US
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Telephone | 616-868-7115
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 140241
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City | GRAND RAPIDS
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State | MI
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Zip | 49514-0241
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Country | US
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Telephone | 616-868-7115
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | VALERIE ALEXANDER
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Credential |
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Telephone | 616-735-1505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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