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1205830759

NPI Code Detail

MEDICARE: DR. JOHN BRET BRUDER MD

MEDICARE: DR. JOHN BRET BRUDER 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	207P00000X	Emergency Medicine Physician	01075910A	IN
2	207P00000X	Emergency Medicine Physician	35081559	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205830759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRET BRUDER MD

Provider Business Mailing Address
First Line	:	1472 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1004
Country	:	US
Telephone Number	:	513-557-3333
Fax Number	:	513-557-3332

Provider Business Practice Location Address
First Line	:	3131 QUEEN CITY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2316
Country	:	US
Telephone Number	:	513-557-3333
Fax Number	:	513-557-3332

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/01/2024

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Directions to “ DR. JOHN BRET BRUDER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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