Individual
BRIAN A BUCKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1471 EAST BELTLINE, STE 201, GRAND RAPIDS, MI 49525
(616) 685-8620
(616) 447-7674
Mailing address
245 STATE ST SE, STE 228, GRAND RAPIDS, MI 49503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301084540
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
381360529
TAX ID
MI
Enumeration date
07/26/2006
Last updated
09/12/2012
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