Active NPI
Michael L. Bruck, M.D., F.A.A.P.
- Pediatrics Physician
- Wellington, FL
National Provider Identifier
1033189055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME-0069990
- Practice address
- 10115 W Forest Hill Blvd.
Suite 402
Wellington, FL 33414 - Phone
- (561) 791-1935
- Fax
- (561) 791-0115
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME-0069990 | FL | Primary |
Addresses
Primary practice location
10115 W Forest Hill Blvd.
Suite 402
Wellington, FL 33414
Mailing address
10115 W Forest Hill Blvd.
Suite 402
Wellington, FL 33414
Phone (561) 791-1935
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME-0069990 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vitalmd Group Holding LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366329600000",
"number": "1033189055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10115 W FOREST HILL BLVD.",
"address_2": "SUITE 402",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "33414",
"telephone_number": "561-791-1935",
"fax_number": "561-791-0115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10115 W FOREST HILL BLVD.",
"address_2": "SUITE 402",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "33414",
"telephone_number": "561-791-1935",
"fax_number": "561-791-0115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCK",
"first_name": "MICHAEL",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "M.D., F.A.A.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2013-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME-0069990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellington, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.