MEDICARE: PETER J BUECKER MD

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	207X00000X	Orthopaedic Surgery Physician	35801	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01572803	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50101088	OTHER	KY	PASSPORT HEALTH PLAN
3	000000995097	OTHER		ANTHEM
4	7556710	OTHER	KY	AETNA PROVIDER NUMB
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134185150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J BUECKER MD

Provider Business Mailing Address
First Line	:	4331 CHURCHMAN AVE
Second Line	:	SUITE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1164
Country	:	US
Telephone Number	:	502-364-0902
Fax Number	:	502-364-0099

Provider Business Practice Location Address
First Line	:	4331 CHURCHMAN AVE
Second Line	:	SUITE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1164
Country	:	US
Telephone Number	:	502-364-0902
Fax Number	:	502-364-0099

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/25/2016

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Directions to “ PETER J BUECKER MD” Practice Location

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