Basic Information
| Provider Information | |||||||||
| NPI: | 1861450280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VON BUN | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292500 | ||||||||
| FaxNumber: | 5026293166 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 GORDON GUTMANN BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471303764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122889969 | ||||||||
| FaxNumber: | 8122889657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 32167 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 6698103 | 01 | KY | CIGNA PROVIDER NUMB | OTHER | 200085120 | 05 | KY | MEDICAID | 5158197 | 01 | KY | AETNA PROVIDER NUMB | OTHER | 000054971B | 01 | KY | HUMANA PROVIDER NUMB | OTHER | 50007896 | 01 | KY | PASSPORT PROVIDER NUMB | OTHER | P00421372 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000365365 | 01 | KY | ANTHEM PROVIDER NUMB | OTHER | 64360589 | 05 | KY | MEDICAID | P00199433 | 01 | IN | RAILROAD MEDICARE | OTHER |