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Individual
MICHAEL BRUNNER
Active
Individual
MICHAEL BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.133928
IL
390200000X
Student in an Organized Health Care Education/Training Program
125055948
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125055948
STATE LICENSE
IL
Enumeration date
07/09/2009
Last updated
03/11/2021
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