Provider Demographics
NPI:1750371571
Name:BUNCKE MEDICAL CLINIC INC.
Entity type:Organization
Organization Name:BUNCKE MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUNCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-565-6136
Mailing Address - Street 1:45 CASTRO ST.
Mailing Address - Street 2:#121
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1010
Mailing Address - Country:US
Mailing Address - Phone:415-565-6136
Mailing Address - Fax:415-864-1654
Practice Address - Street 1:45 CASTRO ST.
Practice Address - Street 2:#121
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1010
Practice Address - Country:US
Practice Address - Phone:415-565-6136
Practice Address - Fax:415-864-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350012086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046560Medicaid
CAZZZ85640ZMedicare PIN