Basic Information
| Provider Information | |||||||||
| NPI: | 1801891965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUNCH | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | CAROL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4130 DUTCHMANS LN | ||||||||
| Address2: | STE 400 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028970697 | ||||||||
| FaxNumber: | 5028970658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25076 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 50036610 | 01 | KY | PASSPORT - WS | OTHER | 610673930 | 01 | KY | EMPLOYER ID | OTHER | 160032456 | 01 | KY | RAILROAD | OTHER | 610673930I | 01 | KY | HUMANA | OTHER | K031770 | 01 | KY | MEDICARE PTAN - WS | OTHER | 0700298 | 01 | KY | UNITED HEALTHCARE | OTHER | 3479000000044476 | 01 | KY | BLUE CROSS/BLUE SHIELD | OTHER | 64250764 | 05 | KY | MEDICAID |