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NPI Code Detail

MEDICARE: BRANDON M BUNGO MD

MEDICARE: BRANDON M BUNGO MD
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
1207R00000XInternal Medicine Physician35.138862OH
2390200000XStudent in an Organized Health Care Education/Training Program
3207RH0003XHematology & Oncology Physician036.156133IL

General Provider Information

NPI Number : 1871026104
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON M BUNGO MD
Provider Business Mailing Address
First Line : 9500 EUCLID AVENUE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195
Country : US
Telephone Number : 216-444-2200
Fax Number :
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST STE 850
Second Line :
City : CHICAGO
State : IL
Zip : 60611-3124
Country : US
Telephone Number : 312-695-6180
Fax Number : 312-695-6189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2017
Last Update Date : 12/09/2024

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