1730405077 NPI number — KURT FREDERICK BRUEGGEMANN M.D.

Table of content: KURT FREDERICK BRUEGGEMANN M.D. (NPI 1730405077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730405077 NPI number — KURT FREDERICK BRUEGGEMANN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUEGGEMANN
Provider First Name:
KURT
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730405077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 E DIVISADERO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93721-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-443-2682
Provider Business Mailing Address Fax Number:
559-443-2681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2823 FRESNO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93721-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-499-6440
Provider Business Practice Location Address Fax Number:
559-499-6441
Provider Enumeration Date:
04/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  A111785 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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