MEDICARE: DR. DENISE J BRUNEAU 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	207V00000X	Obstetrics & Gynecology Physician	39333	KY
2	207V00000X	Obstetrics & Gynecology Physician	M9952	ID
3	207V00000X	Obstetrics & Gynecology Physician	01063541A	IN
4	207V00000X	Obstetrics & Gynecology Physician	MD29651	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00447889	OTHER	ID	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50006911	OTHER	KY	PASSPORT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2448101000	OTHER	KY	PASSPORT ADVANTAGE
7	000000479343	OTHER	KY	ANTHEM
8	000000479340	OTHER	KY	ANTHEM
9	1427076173	OTHER	AL	BCBS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	300579154	OTHER	AL	TRICARE

General Provider Information

NPI Number	:	1427076173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE J BRUNEAU MD

Provider Business Mailing Address
First Line	:	PO BOX 950187
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0187
Country	:	US
Telephone Number	:	502-253-1035
Fax Number	:	502-253-1037

Provider Business Practice Location Address
First Line	:	140 STONECREST RD
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8142
Country	:	US
Telephone Number	:	502-633-0094
Fax Number	:	502-633-0033

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	10/25/2012

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Directions to “ DR. DENISE J BRUNEAU MD” Practice Location

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