MEDICARE: KERSTI M BRUINING MD PLLC

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	174400000X	Specialist	4301062455	MI

General Provider Information

NPI Number	:	1588778088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERSTI M BRUINING MD PLLC

Provider Business Mailing Address
First Line	:	1213 W FRONT ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2317
Country	:	US
Telephone Number	:	231-935-0386
Fax Number	:	231-935-0387

Provider Business Practice Location Address
First Line	:	1213 W FRONT ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2317
Country	:	US
Telephone Number	:	231-935-0386
Fax Number	:	231-935-0387

Authorized Official
Title or Position	:	OWNER
Name	:	KERSTI BRUINING
Credential	:	MD
Telephone Number	:	231-935-0386

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	01/11/2011

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