1760477723 NPI number — DR. FREDERICK A BUNGE M.D.

Table of content: (NPI 1285248518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760477723 NPI number — DR. FREDERICK A BUNGE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNGE
Provider First Name:
FREDERICK
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760477723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 OAK RIDGE TPKE
Provider Second Line Business Mailing Address:
SUITE C 100
Provider Business Mailing Address City Name:
OAK RIDGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37830-6957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-483-2288
Provider Business Mailing Address Fax Number:
865-482-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OAK RIDGE TPKE
Provider Second Line Business Practice Location Address:
SUITE C 100
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-6957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-483-2288
Provider Business Practice Location Address Fax Number:
865-482-4400
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  49517 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X , with the licence number: 45832 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000392339 . This is a "ANTHEM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00335204 . This is a "RRMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00752932 . This is a "RRM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 143906 . This is a "PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1532553 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01370 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000284025 . This is a "UNISON AGED BLIND & DISABLED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 23604 . This is a "HPM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100236970 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000604434 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4243846 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4876691 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0891790 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 157558 . This is a "GLHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1704610842 . This is a "BCBS MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00979695 . This is a "RRMC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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