Individual
MICHAEL J BUCKMASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 REID PKWY, SUITE 215, RICHMOND, IN 47374-1157
(765) 939-9331
(765) 939-9314
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 939-9331
(765) 939-9314
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01048422A
IN
2086S0129X
Vascular Surgery Physician
Primary
01048422A
IN
2086S0129X
Vascular Surgery Physician
35.090263
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000705159
ANTHEM
—
05
—
200180440
—
IN
05
—
2072135
—
OH
Enumeration date
06/14/2005
Last updated
09/14/2016
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