Provider Demographics
NPI:1609531821
Name:BUNDY, ADAM MICHAEL
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:BUNDY
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 1:218 FAST ICE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6167
Mailing Address - Country:US
Mailing Address - Phone:989-631-2320
Mailing Address - Fax:
Practice Address - Street 1:5975 WENDT RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:MI
Practice Address - Zip Code:48628-9792
Practice Address - Country:US
Practice Address - Phone:989-404-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator