Provider Demographics
NPI:1750493433
Name:BUNCH, BRIAN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:BUNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WESTHILL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4706
Mailing Address - Country:US
Mailing Address - Phone:715-847-2019
Mailing Address - Fax:715-847-2668
Practice Address - Street 1:3200 WESTHILL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4706
Practice Address - Country:US
Practice Address - Phone:715-847-2019
Practice Address - Fax:715-847-2668
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40739207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34802400Medicaid
WI34802400Medicaid