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NPI Code Detail

MEDICARE: GEORGE S BRUINS MD

MEDICARE: GEORGE S BRUINS 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
1207Q00000XFamily Medicine Physician4301057804MI

Other Identifiers

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

General Provider Information

NPI Number : 1265436836
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE S BRUINS MD
Provider Business Mailing Address
First Line : 4600 BRETON RD SE
Second Line : STE 102
City : KENTWOOD
State : MI
Zip : 49508-5220
Country : US
Telephone Number : 616-391-9700
Fax Number : 616-391-9707
Provider Business Practice Location Address
First Line : 4600 BRETON RD SE
Second Line : STE 102
City : KENTWOOD
State : MI
Zip : 49508-5220
Country : US
Telephone Number : 616-391-9700
Fax Number : 616-391-9707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 03/16/2011

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