Healthcare Provider Details

I. General information

NPI: 1881645422
Provider Name (Legal Business Name): HEATHER BUNTING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3876 E PARIS AVE SE
GRAND RAPIDS MI
49512-3974
US

IV. Provider business mailing address

950 36TH ST SW
GRAND RAPIDS MI
49509-3587
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-8000
  • Fax:
Mailing address:
  • Phone: 616-320-0405
  • Fax: 616-320-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301076362
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: