Healthcare Provider Details

I. General information

NPI: 1053006601
Provider Name (Legal Business Name): COTY BUCHWALTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

IV. Provider business mailing address

222 W MAPLE ST APT 1207
JEFFERSONVILLE IN
47130-3508
US

V. Phone/Fax

Practice location:
  • Phone: 269-982-4941
  • Fax:
Mailing address:
  • Phone: 219-669-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02008865A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: