Individual
BRIAN BRUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16329 WEBER RD, LOCKPORT, IL 60441-6558
(815) 274-8248
Mailing address
16329 WEBER RD, LOCKPORT, IL 60441-6558
(815) 274-8248
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036.053254
IL
Other
Enumeration date
10/03/2009
Last updated
10/03/2009
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