| NPI | 1316085897 |
|---|---|
| Former Name | KELLY MICHELLE BRUNGARDT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036126038) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0064374) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2011-04-20 |