Provider Demographics
NPI:1679563019
Name:BARACH, BRUCE K (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:K
Last Name:BARACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:14490 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4821
Practice Address - Country:US
Practice Address - Phone:843-881-4440
Practice Address - Fax:843-314-0785
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC34698208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56061BMedicare PIN
D02348Medicare UPIN