Basic Information
| Provider Information | |||||||||
| NPI: | 1649230392 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUNKERS | ||||||||
| FirstName: | KARI | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 NW 26TH ST | ||||||||
| Address2: | |||||||||
| City: | OWATONNA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550605503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074511120 | ||||||||
| FaxNumber: | 5074446287 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 NW 26TH ST | ||||||||
| Address2: | |||||||||
| City: | OWATONNA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550605503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074511120 | ||||||||
| FaxNumber: | 5074446287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2006 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34562 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 625063700 | 05 | MN | MEDICAID |