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General NPI Number Information
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NPI Number | 1417261041
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Entity Type | Individual
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Provider Name | ERIN KATHLEEN BUCKLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 180 S MAIN ST
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City | CANTON
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State | IL
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Zip | 61520
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Country | US
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Telephone | 309-647-0201
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Fax | 309-649-8951
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Provider Business Mailing Address
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Address Line | 621 S NEW BALLAS RD STE 4017B
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8269
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Country | US
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Telephone | 314-872-9192
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Fax | 314-872-4234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036131875
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2018015066
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License Number State | MO
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