MEDICARE: DR. STEPHANIE MICHAL BRUNS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35-126339	OH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	202102083	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013274778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE MICHAL BRUNS MD

Provider Business Mailing Address
First Line	:	5960 FAIRVIEW RD STE 500
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3113
Country	:	US
Telephone Number	:	704-495-6334
Fax Number	:	844-624-2406

Provider Business Practice Location Address
First Line	:	11030 GOLF LINKS DR STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8047
Country	:	US
Telephone Number	:	704-495-6970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	01/23/2023

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