Provider Demographics
NPI:1427076173
Name:BRUNEAU, DENISE J (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:J
Last Name:BRUNEAU
Suffix:
Gender:F
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:PO BOX 950187
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0187
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:140 STONECREST RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8142
Practice Address - Country:US
Practice Address - Phone:502-633-0094
Practice Address - Fax:502-633-0033
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39333207V00000X
IDM9952207V00000X
IN01063541A207V00000X
ALMD29651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50006911OtherPASSPORT
KY64098163Medicaid
ID807828200Medicaid
IDP00447889OtherRAILROAD MEDICARE
IN200909000Medicaid
KY2448101000OtherPASSPORT ADVANTAGE
KY000000479343OtherANTHEM
KY000000479340OtherANTHEM
AL1427076173OtherBCBS
AL116318Medicaid
AL300579154OtherTRICARE
KY000000479340OtherANTHEM
ID1100088Medicare PIN
KY0263010Medicare ID - Type Unspecified
ID807828200Medicaid