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NPI Code Detail

MEDICARE: DR. KERSTI BRUINING M.D.

MEDICARE: DR. KERSTI BRUINING 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
1174400000XSpecialist4301062455MI
22084N0400XNeurology Physician4301062455MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14301062455OTHERMISTATE LICENSE NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30281047OTHERMIBCBS NUMBER

General Provider Information

NPI Number : 1558364315
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KERSTI BRUINING M.D.
Provider Business Mailing Address
First Line : 3537 W FRONT ST STE A
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7942
Country : US
Telephone Number : 231-935-9700
Fax Number : 231-935-9706
Provider Business Practice Location Address
First Line : 1105 SIXTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-935-7514
Fax Number : 231-392-0039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 02/10/2026

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Directions to “ DR. KERSTI BRUINING M.D.” Practice Location

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