Healthcare Provider Details

I. General information

NPI: 1417261041
Provider Name (Legal Business Name): ERIN KATHLEEN BUCKLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN KATHLEEN BARKAU M.D.

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S MAIN ST
CANTON IL
61520
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 4017B
SAINT LOUIS MO
63141-8269
US

V. Phone/Fax

Practice location:
  • Phone: 309-647-0201
  • Fax: 309-649-8951
Mailing address:
  • Phone: 314-872-9192
  • Fax: 314-872-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036131875
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2018015066
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: