Healthcare Provider Details

I. General information

NPI: 1245226802
Provider Name (Legal Business Name): RENEE GRIFFIN BUCHANAN PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS RENEE L GRIFFIN

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NORTHWEST HWY STE 107
FOX RIVER GROVE IL
60021-1925
US

IV. Provider business mailing address

1340 RYAN PKWY
ALGONQUIN IL
60102-4527
US

V. Phone/Fax

Practice location:
  • Phone: 847-462-5100
  • Fax: 847-462-5101
Mailing address:
  • Phone: 815-276-0150
  • Fax: 877-461-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: