MEDICARE: BRANDON MICHAEL BUNKLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374700000X	Technician

General Provider Information

NPI Number	:	1578305512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON MICHAEL BUNKLEY

Provider Business Mailing Address
First Line	:	3428 ASHBY RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-4218
Country	:	US
Telephone Number	:	216-758-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	3428 ASHBY RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-4218
Country	:	US
Telephone Number	:	216-758-1304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ BRANDON MICHAEL BUNKLEY ” Practice Location

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