Provider Demographics
NPI:1386860096
Name:ROBERT J. BUNGE, M.D., PSC
Entity Type:Organization
Organization Name:ROBERT J. BUNGE, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-223-6700
Mailing Address - Street 1:3121 WALL ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1711
Mailing Address - Country:US
Mailing Address - Phone:859-223-6700
Mailing Address - Fax:859-223-5202
Practice Address - Street 1:3121 WALL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1711
Practice Address - Country:US
Practice Address - Phone:859-223-6700
Practice Address - Fax:859-223-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1396727079OtherINDIVIDUAL PROVIDER NPI
KY000000048820OtherANTHEM
KY64225238Medicaid
KYC68367Medicare UPIN
KY0083802Medicare PIN
KY0838Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER