Individual
LARRY R BRUNZLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 SOUTH GIBSON STREET, MEDFORD, WI 54451
(715) 748-8100
(715) 748-7590
Mailing address
135 SOUTH GIBSON STREET, MEDFORD, WI 54451
(715) 748-8100
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
24477
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30461100
—
WI
Enumeration date
12/19/2006
Last updated
05/15/2012
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