MEDICARE: HERMINE ISABEL BRUNNER 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	2080P0216X	Pediatric Rheumatology Physician	35080711	OH

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	:	1124011259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMINE ISABEL BRUNNER MD

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	MLC 4010
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:	MLC 4010
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4676
Fax Number	:	513-636-5568

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	12/01/2014

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