Provider Demographics
NPI:1962405324
Name:BRUNER, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BRUNER
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 1:1200 SCHWEGLER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7558
Mailing Address - Country:US
Mailing Address - Phone:785-864-9525
Mailing Address - Fax:785-864-9596
Practice Address - Street 1:1200 SCHWEGLER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7558
Practice Address - Country:US
Practice Address - Phone:785-964-9525
Practice Address - Fax:785-864-9596
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0415429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100085330EMedicaid
KSB91079Medicare UPIN
KS100085330EMedicaid