Healthcare Provider Details

I. General information

NPI: 1902803729
Provider Name (Legal Business Name): JENNIFER JO BUCKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD SUITE 355
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

720 N LINCOLN ST
GREENSBURG IN
47240-1327
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-8425
  • Fax: 317-924-8424
Mailing address:
  • Phone: 812-663-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01041552
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: