Provider Demographics
NPI:1366533507
Name:BRUNIK, PAUL HANK (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HANK
Last Name:BRUNIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-5099
Mailing Address - Fax:320-229-5171
Practice Address - Street 1:1900 CENTRACARE CIRCLE
Practice Address - Street 2:SUITE 2400
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-5099
Practice Address - Fax:320-229-5171
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31519207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN188895100Medicaid
MN1366533507Medicare PIN