Individual
BRYAN P PUCIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1230 E. MAIN STREET, MANKATO CLINIC @ MAIN STREET, MANKATO, MN 56002-8674
(507) 625-1811
Mailing address
PO BOX 8674 1230 E. MAIN STREET, MANKATO CLINIC, LTD, MANKATO, MN 56002-8674
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37212
MN
207Q00000X
Family Medicine Physician
53516
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0118371
MEDICA
MN
01
—
080159110
RR MEDICARE
—
01
—
101792
UCARE
MN
01
—
1675630
AMERICAS PPO
MN
01
—
410849339 56001 C173
CHAMPUS
—
01
—
56BO8PU
BCBS
MN
05
—
805722200
—
MN
01
—
HP18443
HEALTH PARTNERS
MN
01
—
NA2951023852
PREFERRED ONE
MN
Enumeration date
01/10/2006
Last updated
07/15/2020
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