Provider Demographics
NPI:1285734459
Name:WINNER, BRUCE KENT (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:KENT
Last Name:WINNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7806
Mailing Address - Fax:269-341-8743
Practice Address - Street 1:680 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3028
Practice Address - Country:US
Practice Address - Phone:269-965-4500
Practice Address - Fax:269-965-1150
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBW057232208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285734459Medicaid
MI700C910950OtherBCBSM
MI080101081OtherRAILROAD MEDICARE
MIBW057232OtherBCNBC
MIBW057232OtherBCNBC
MI0M31600002Medicare ID - Type Unspecified
MI080101081OtherRAILROAD MEDICARE