Individual
YAIMET VIDAL BUCKNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
Mailing address
2650 RIDGE AVE STE 1223, EVANSTON, IL 60201-1700
(847) 570-2040
(847) 733-5315
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036123195
IL
208M00000X
Hospitalist Physician
Primary
036123195
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036123195
STATE LICENSE
IL
Enumeration date
05/06/2009
Last updated
10/21/2025
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