Healthcare Provider Details

I. General information

NPI: 1528974771
Provider Name (Legal Business Name): CORY MICHEAL BUNTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2862 E HIGH ST
SPRINGFIELD OH
45505-1437
US

IV. Provider business mailing address

2862 E HIGH ST
SPRINGFIELD OH
45505-1437
US

V. Phone/Fax

Practice location:
  • Phone: 937-561-0168
  • Fax:
Mailing address:
  • Phone: 937-561-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: