Provider Demographics
NPI:1679956205
Name:BRUN, SCOTT C (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:BRUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:31048 PRAIRIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4898
Mailing Address - Country:US
Mailing Address - Phone:847-935-1293
Mailing Address - Fax:
Practice Address - Street 1:1 N WAUKEGAN RD
Practice Address - Street 2:DEPT R435, BLDG AP30-3
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-1802
Practice Address - Country:US
Practice Address - Phone:847-935-1293
Practice Address - Fax:847-938-3711
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036095736207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology