Individual
DR. RUSSEL VERNE BRUBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1939 DIVISION AVE S, GRAND RAPIDS, MI 49507-2480
(616) 247-3815
(616) 245-0450
Mailing address
PO BOX 44, ALTO, MI 49302-0044
(616) 868-7115
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301040147
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4166801
—
MI
01
—
RB040147
BCBS PIN
MI
Enumeration date
09/25/2006
Last updated
11/06/2024
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