MEDICARE: PETER R BRUMLIK P.A., PHD

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	363A00000X	Physician Assistant

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	:	1235219429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER R BRUMLIK P.A., PHD

Provider Business Mailing Address
First Line	:	2020 N ACADEMY BLVD
Second Line	:	SUITE 155
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	719-380-7210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD
Second Line	:	SUITE 155
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	719-380-7210
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	10/25/2007

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