Michael David Brunner, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP4417 Issued in MN

Practice address

445 Etna St
Saint Paul, MN 55106-5857

Phone

(651) 254-4804

NPI assigned

Jan 14, 2006

Last updated

May 12, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hampton Newport News Community Services Board

  • Community/Behavioral Health Agency
  • Hampton, VA
  • NPI 1659424448
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494547200000",
    "number": "1093794349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 ETNA ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551065857",
            "telephone_number": "651-254-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 ETNA ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551065857",
            "telephone_number": "651-254-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-14",
        "last_updated": "2017-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175177800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shayla Rebecca Bruhn
• Katherine Daisy Brula, APRN, CNP
• Jacque Therese Brumm
• Lindsey Brumm
• Jeremy Brunner
• Susan Brunner, CRNA
• Michael Brunnquell, M.D.
• Rodd Barclay Bruntjen, DC
• Kendra Brush
• Kristen Elizabeth Brush, DPT

• Psychologist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.