Healthcare Provider Details

I. General information

NPI: 1346239407
Provider Name (Legal Business Name): JENNIFER R BUNCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N CELIA AVE
MUNCIE IN
47303-4609
US

IV. Provider business mailing address

221 N CELIA AVE
MUNCIE IN
47303-4609
US

V. Phone/Fax

Practice location:
  • Phone: 765-741-2999
  • Fax: 765-747-3175
Mailing address:
  • Phone: 765-282-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01050873
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: