Individual
BRUCE D HARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5215 HOLY CROSS PKWY, EMERGENCY DEPARTMENT, MISHAWAKA, IN 46545-1469
(574) 335-5000
Mailing address
5215 HOLY CROSS PKWY, EMERGENCY DEPARTMENT, MISHAWAKA, IN 46545-1469
(574) 335-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01058929
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000341270
ANTHEM
IN
05
—
104645783
—
MI
05
—
200491230
—
IN
01
—
P00178962
RAIL ROAD MEDICARE
IN
Enumeration date
11/28/2005
Last updated
12/16/2011
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