Provider Demographics
NPI:1801891965
Name:BUNCH, SUSAN CAROL (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:BUNCH
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:STE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4711
Practice Address - Country:US
Practice Address - Phone:502-897-0697
Practice Address - Fax:502-897-0658
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25076207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50036610OtherPASSPORT - WS
KY610673930OtherEMPLOYER ID
KY160032456OtherRAILROAD
KY610673930IOtherHUMANA
KYK031770OtherMEDICARE PTAN - WS
KY0700298OtherUNITED HEALTHCARE
KY3479000000044476OtherBLUE CROSS/BLUE SHIELD
KY64250764Medicaid
KYK031770OtherMEDICARE PTAN - WS
KY3479000000044476OtherBLUE CROSS/BLUE SHIELD