Provider Demographics
NPI:1902982291
Name:BRUNECKY, ALICE (MD, DABMA)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:BRUNECKY
Suffix:
Gender:F
Credentials:MD, DABMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11986 W 70TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-2524
Mailing Address - Country:US
Mailing Address - Phone:303-438-2050
Mailing Address - Fax:
Practice Address - Street 1:7050 W 120TH AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2801
Practice Address - Country:US
Practice Address - Phone:303-438-2050
Practice Address - Fax:303-438-6644
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine