MEDICARE: DR. HANNELORE AUGUST BRUCKER M.D.

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	207K00000X	Allergy & Immunology Physician	23905	MN

General Provider Information

NPI Number	:	1518960095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANNELORE AUGUST BRUCKER M.D.

Provider Business Mailing Address
First Line	:	7300 FRANCE AVE S
Second Line	:	SUITE 204
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55435-4525
Country	:	US
Telephone Number	:	952-926-7630
Fax Number	:	952-926-2116

Provider Business Practice Location Address
First Line	:	4010 W 65TH ST
Second Line	:	STE 221
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55435-1706
Country	:	US
Telephone Number	:	952-926-7630
Fax Number	:	952-926-2116

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/15/2014

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