Provider Demographics
NPI:1881645422
Name:BUNTING, HEATHER (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BUNTING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 36TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3587
Mailing Address - Country:US
Mailing Address - Phone:616-320-0405
Mailing Address - Fax:616-320-0406
Practice Address - Street 1:3876 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-3974
Practice Address - Country:US
Practice Address - Phone:616-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4518904Medicaid
MI4518931Medicaid
MI4876771Medicaid
MI4518790Medicaid
MI4518860Medicaid
MI4518824Medicaid
MI4518898Medicaid
MI4518780Medicaid
MI4518842Medicaid
MI4518913Medicaid
MI4518815Medicaid
MI4518851Medicaid
MI4518922Medicaid
MI4518771Medicaid
MI4518806Medicaid
MI4518833Medicaid
MI4518824Medicaid
MI4518913Medicaid
MI4518815Medicaid
MI4518771Medicaid