Individual
MICHAEL BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1041 W STEARNS RD, BARTLETT, IL 60103-4509
(630) 716-7500
Mailing address
1515 E LAKE ST, ATTN: ABMG PRIMARY CARE, HANOVER PARK, IL 60133-4869
(630) 483-3200
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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