MEDICARE: BRUCE D LIRONES DO

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	207Q00000X	Family Medicine Physician	5101008200	MI

General Provider Information

NPI Number	:	1881786762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE D LIRONES DO

Provider Business Mailing Address
First Line	:	9895 RAPID CITY RD NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-9506
Country	:	US
Telephone Number	:	231-331-4283
Fax Number	:	231-331-6115

Provider Business Practice Location Address
First Line	:	9895 RAPID CITY RD NW
Second Line	:
City	:	RAPID CITY
State	:	MI
Zip	:	49676-9506
Country	:	US
Telephone Number	:	231-331-4283
Fax Number	:	231-331-6115

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	12/15/2009

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Directions to “ BRUCE D LIRONES DO” Practice Location

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