Provider Demographics
NPI:1821020819
Name:BAMBENEK, JOHN C III (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:BAMBENEK
Suffix:III
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 1:2015 MAXWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711
Mailing Address - Country:US
Mailing Address - Phone:812-422-7974
Mailing Address - Fax:812-422-8163
Practice Address - Street 1:2015 MAXWELL AVENUE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711
Practice Address - Country:US
Practice Address - Phone:812-422-7974
Practice Address - Fax:812-422-8163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047200A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200149890AMedicaid
F87482Medicare UPIN
IN200149890AMedicaid