Provider Demographics
NPI:1487627634
Name:BUNDSCHUH, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BUNDSCHUH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-3500
Mailing Address - Fax:
Practice Address - Street 1:7400 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6432
Practice Address - Country:US
Practice Address - Phone:480-882-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4225207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00298501OtherRR MEDICARE
AZ934233Medicaid
AZZWCGCROtherGROUP MEDICARE NUMBER
AZZWCGCROtherGROUP MEDICARE NUMBER
AZ934233Medicaid