MEDICARE: DR. KYLE FITZGERALD BUCHER M.D.

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	35083206	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35083206	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1265702005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE FITZGERALD BUCHER M.D.

Provider Business Mailing Address
First Line	:	3355 GLENDALE AVE
Second Line	:	THIRD FLOOR
City	:	TOLEDO
State	:	OH
Zip	:	43614-2426
Country	:	US
Telephone Number	:	419-383-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ARLINGTON AVE
Second Line	:	MS 1186
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-383-4000
Fax Number	:	419-383-5618

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	07/02/2013

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