Individual
DR. CHARLES R. BUCHANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 COMMERCIAL DR, MAHOMET, IL 61853-8625
(217) 586-6600
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-107702
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107702 1
—
IL
01
—
080191099
RAILROAD MEDICARE
IL
01
—
279500
MEDICARE GROUP
IL
Enumeration date
08/01/2006
Last updated
07/29/2014
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