MEDICARE: BRUECK, GOLOSOW, KIM & ASSOCIATES

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	2086S0122X	Plastic and Reconstructive Surgery Physician	ME33768	FL

General Provider Information

NPI Number	:	1548452378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUECK, GOLOSOW, KIM & ASSOCIATES

Provider Business Mailing Address
First Line	:	6842 INTERNATIONAL CENTER BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7129
Country	:	US
Telephone Number	:	239-939-5233
Fax Number	:	239-938-2933

Provider Business Practice Location Address
First Line	:	3700 CENTRAL AVE
Second Line	:	STE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7649
Country	:	US
Telephone Number	:	239-939-5233
Fax Number	:	239-939-9225

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SUSAN M. HANZEVACK
Credential	:
Telephone Number	:	239-939-5233

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	05/16/2025

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Directions to “BRUECK, GOLOSOW, KIM & ASSOCIATES ” Practice Location

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