Individual
MARY R BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1650 W OAK ST, SUITE 210, ZIONSVILLE, IN 46077-3836
(317) 873-8855
(317) 873-8853
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01040340
IN
208000000X
Pediatrics Physician
Primary
01040340A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100350650
—
IN
Enumeration date
06/10/2006
Last updated
08/30/2022
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