Provider Demographics
NPI:1790874691
Name:BUNDSCHU, MILTON RANDOLPH JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:RANDOLPH
Last Name:BUNDSCHU
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:235 DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2839
Mailing Address - Country:US
Mailing Address - Phone:404-687-0557
Mailing Address - Fax:
Practice Address - Street 1:CARDIO-THORACIC SURGERY
Practice Address - Street 2:1365 CLIFTON ROAD
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-778-3567
Practice Address - Fax:404-778-4346
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA000891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR74344001Medicare UPIN
GA97BBBCV01Medicare ID - Type Unspecified