Provider Demographics
NPI:1356334692
Name:BRUNSTING, LOUIS A III (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:BRUNSTING
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 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4721
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:10496 MONTGOMERY RD STE 104
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-865-5120
Practice Address - Fax:513-865-5121
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31578208G00000X
OH35.096211208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL169836Medicaid
TN2087215Medicaid
AL511-57428OtherBCBS OF AL, 2375 CHAMPIONS BLVD, AUBURN
AL511-57708OtherBCBS OF AL, 2000 PEPPERELL PKWY, OPELIKA
AL6420160OtherMULTIPLAN
AL169226Medicaid
4609774OtherAETNA
7246414-010OtherCIGNA
0199333OtherBCBS
TNP00010965OtherRAILROAD MEDICARE
TN3087817Medicaid
TN4047180OtherBCBS
TN10071071OtherAMERIGROUP COMMUNITY CARE
KY64921315OtherKY MEDICAID
TNTN0102OtherAMERICHOICE
TNP00010965OtherRAILROAD MEDICARE
TN2087215Medicaid