Provider Demographics
NPI:1376257931
Name:BUNDU, HABIB
Entity Type:Individual
Prefix:
First Name:HABIB
Middle Name:
Last Name:BUNDU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7997 WORTHINGTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5564
Mailing Address - Country:US
Mailing Address - Phone:614-805-6031
Mailing Address - Fax:
Practice Address - Street 1:7997 WORTHINGTON LAKE DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-5564
Practice Address - Country:US
Practice Address - Phone:614-805-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty