Provider Demographics
NPI:1093950479
Name:BUNTE, MICHAEL EVERETT
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EVERETT
Last Name:BUNTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42806 CLUN LN
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-8272
Mailing Address - Country:US
Mailing Address - Phone:608-872-2207
Mailing Address - Fax:
Practice Address - Street 1:42806 CLUN LN
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-8272
Practice Address - Country:US
Practice Address - Phone:608-872-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302887-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse