Healthcare Provider Details

I. General information

NPI: 1639150089
Provider Name (Legal Business Name): PRESLEY T BUNTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6085 HEARTLAND DR STE 205
ZIONSVILLE IN
46077-4433
US

IV. Provider business mailing address

2705 N LEBANON ST STE 305
LEBANON IN
46052-8622
US

V. Phone/Fax

Practice location:
  • Phone: 317-768-2210
  • Fax: 317-768-2209
Mailing address:
  • Phone: 765-485-8852
  • Fax: 765-485-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01022686A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: