MEDICARE: GEORGE V BUCCIERO DPM

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	213E00000X	Podiatrist	016003552	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154309888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE V BUCCIERO DPM

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-0967
Country	:	US
Telephone Number	:	708-532-6029
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E HURON ST
Second Line	:	SUITE 801
City	:	CHICAGO
State	:	IL
Zip	:	60611-2999
Country	:	US
Telephone Number	:	312-337-2468
Fax Number	:	312-337-6912

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/20/2015

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Practice Fax:

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