Individual
MICHAEL DAVID BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
445 ETNA ST, SAINT PAUL, MN 55106-5857
(651) 254-4804
Mailing address
445 ETNA ST, SAINT PAUL, MN 55106-5857
(651) 254-4804
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4417
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175177800
—
MN
Enumeration date
01/14/2006
Last updated
05/12/2017
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