1356024988 NPI number — MADELIENE BRUDERER

Table of content: MADELIENE BRUDERER (NPI 1356024988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356024988 NPI number — MADELIENE BRUDERER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUDERER
Provider First Name:
MADELIENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1356024988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CU2RE PROGRAM - DEPT. OF FAMILY AND COMMUNITY MEDICINE
Provider Second Line Business Mailing Address:
930 20TH STREET SOUTH
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-801-1233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2822 THORNHILL RD APT 272A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN BRK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35213-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-801-1233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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