Provider Demographics
NPI:1760477723
Name:BUNGE, FREDERICK A (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
Last Name:BUNGE
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 1:800 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE C 100
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6957
Mailing Address - Country:US
Mailing Address - Phone:865-483-2288
Mailing Address - Fax:865-482-4400
Practice Address - Street 1:800 OAK RIDGE TPKE
Practice Address - Street 2:SUITE C 100
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6957
Practice Address - Country:US
Practice Address - Phone:865-483-2288
Practice Address - Fax:865-482-4400
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49517207Y00000X
KY45832207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000392339OtherANTHEM
P00335204OtherRRMC
P00752932OtherRRM
143906OtherPRIORITY HEALTH
TN1532553Medicaid
OH01370OtherPARAMOUNT
OH000000284025OtherUNISON AGED BLIND & DISABLED
23604OtherHPM
KY7100236970Medicaid
000000604434OtherANTHEM
MI4243846OtherAETNA
MI4876691Medicaid
OH0891790Medicaid
157558OtherGLHP
MI1704610842OtherBCBS MI
OHP00979695OtherRRMC
P00335204OtherRRMC
OH000000284025OtherUNISON AGED BLIND & DISABLED
MI4243846OtherAETNA
MI000000392339OtherANTHEM
OHE80222Medicare UPIN
KYK081760Medicare PIN
TN103I042688Medicare PIN
OH01370OtherPARAMOUNT
OHBU0718052Medicare ID - Type Unspecified
OHBU0718058Medicare PIN
OHP00979695OtherRRMC
OHBU0718056Medicare PIN