Provider Demographics
NPI:1932191913
Name:BUNDE, DAVID K (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:BUNDE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2568
Practice Address - Country:US
Practice Address - Phone:260-463-9054
Practice Address - Fax:260-463-9479
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000309A363A00000X
FLPA9104885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS55577Medicare UPIN
CT745Medicare PIN
IN058940DDMedicare ID - Type Unspecified