=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750900940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON MICHAEL BUCZKO NP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2020
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3550 BRIARFIELD BLVD STE 300
-----------------------------------------------------
City | MAUMEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43537-8916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-452-2140
-----------------------------------------------------
Fax | 419-873-6327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 ROSEHILL RD
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49202-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-212-2008
-----------------------------------------------------
Fax | 517-212-2009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.026143
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------