Individual
MARK D BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D. O.
Contact information
Practice address
19333 W NORTH AVE, BROOKFIELD, WI 53045-4132
(262) 785-2060
Mailing address
10625 W NORTH AVE, WAUWATOSA, WI 53226-2315
(414) 877-5350
(414) 877-5360
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25131
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30019300
—
WI
05
—
32658800
—
WI
01
—
391204982014
BLUE CROSS GROUP
WI
Enumeration date
08/31/2006
Last updated
07/30/2014
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