Basic Information
| Provider Information | |||||||||
| NPI: | 1760477723 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUNGE | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 OAK RIDGE TPKE | ||||||||
| Address2: | SUITE C 100 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654832288 | ||||||||
| FaxNumber: | 8654824400 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 OAK RIDGE TPKE | ||||||||
| Address2: | SUITE C 100 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654832288 | ||||||||
| FaxNumber: | 8654824400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 49517 | TN | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 45832 | KY | N | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 000000392339 | 01 | MI | ANTHEM | OTHER | P00335204 | 01 | RRMC | OTHER | P00752932 | 01 | RRM | OTHER | 143906 | 01 | PRIORITY HEALTH | OTHER | 1532553 | 05 | TN | MEDICAID | 01370 | 01 | OH | PARAMOUNT | OTHER | 000000284025 | 01 | OH | UNISON AGED BLIND & DISABLED | OTHER | 23604 | 01 | HPM | OTHER | 7100236970 | 05 | KY | MEDICAID | 000000604434 | 01 | ANTHEM | OTHER | 4243846 | 01 | MI | AETNA | OTHER | 4876691 | 05 | MI | MEDICAID | 0891790 | 05 | OH | MEDICAID | 157558 | 01 | GLHP | OTHER | 1704610842 | 01 | MI | BCBS MI | OTHER | P00979695 | 01 | OH | RRMC | OTHER |