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NPI Code Detail

MEDICARE: DR. RUSSEL VERNE BRUBAKER MD

MEDICARE: DR. RUSSEL VERNE BRUBAKER 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
12084P0800XPsychiatry Physician4301040147MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2RB040147OTHERMIBCBS PIN

General Provider Information

NPI Number : 1437259793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSEL VERNE BRUBAKER MD
Provider Business Mailing Address
First Line : PO BOX 44
Second Line :
City : ALTO
State : MI
Zip : 49302-0044
Country : US
Telephone Number : 616-868-7115
Fax Number :
Provider Business Practice Location Address
First Line : 1939 DIVISION AVE S
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-2480
Country : US
Telephone Number : 616-247-3815
Fax Number : 616-245-0450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 11/06/2024

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