Provider Demographics
NPI:1427080530
Name:BRUNO, EDDY SEVERE (MD)
Entity type:Individual
Prefix:DR
First Name:EDDY
Middle Name:SEVERE
Last Name:BRUNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDDY
Other - Middle Name:SEVERE
Other - Last Name:BRUNOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0217
Mailing Address - Country:US
Mailing Address - Phone:419-225-8808
Mailing Address - Fax:419-222-7220
Practice Address - Street 1:920 W MARKET ST
Practice Address - Street 2:SUITE 310
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2773
Practice Address - Country:US
Practice Address - Phone:419-225-8808
Practice Address - Fax:419-222-7220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350826302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2582709Medicaid
OH2582709Medicaid
OHI05336Medicare UPIN