MEDICARE: DR. MICHAEL JOHN BUCHENIC IV DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	34017528	OH

General Provider Information

NPI Number	:	1124608278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN BUCHENIC IV DO

Provider Business Mailing Address
First Line	:	400 TOWN CENTER AVE STE 301
Second Line	:
City	:	COLUMBIANA
State	:	OH
Zip	:	44408-8312
Country	:	US
Telephone Number	:	330-482-3871
Fax Number	:	330-482-0133

Provider Business Practice Location Address
First Line	:	400 TOWN CENTER AVE STE 301
Second Line	:
City	:	COLUMBIANA
State	:	OH
Zip	:	44408-8312
Country	:	US
Telephone Number	:	330-482-3871
Fax Number	:	330-482-0133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	01/06/2025

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