Bruder, Wallace John
Bruder, Wallace John is an individual health care provider with primary practice located at 4045 W Royal Dr , Traverse City MI 49684-8965. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Bruder, Wallace John can be contacted via phone (231) 935-0900.Contact Information
Primary practice address
4045 W Royal Dr
Traverse City MI 49684-8965
Phone: (231) 935-0900
Fax: (231) 935-0308
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 4301033897 | Michigan |
Profile Details
| NPI number | 1396769220 |
|---|---|
| LBN Legal business name | Bruder, Wallace John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 26th, 2006 |
| Last updated | Feb 3rd, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396769220 | NPPES |
| Michigan | MEDICAID | 103104985 |
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