Individual
JASON BRUNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
4111 FRANKLIN ST, MICHIGAN CITY, IN 46360-7803
(219) 873-2919
(219) 873-2909
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28235051A
IN
363LF0000X
Family Nurse Practitioner
Primary
71008913A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300025272
—
IN
01
—
471400568
MEDICARE
IN
Enumeration date
03/29/2019
Last updated
12/20/2022
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