Individual
WILLIAM CARLIN BUCKNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1018 GAMMON LN, MADISON, WI 53719-2256
(608) 417-8144
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
043167
MI
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
54298
WI
2084P0800X
Psychiatry Physician
043167
MI
2084P0800X
Psychiatry Physician
Primary
54298
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1674010
—
MI
Enumeration date
06/21/2006
Last updated
12/07/2016
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