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1295722635

NPI Code Detail

MEDICARE: HEIDI BUCKINGHAM MD

MEDICARE: HEIDI BUCKINGHAM 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	024501	LA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35.089021	OH

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	:	1295722635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI BUCKINGHAM MD

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	400 SUGAR CAMP CIR STE 205
Second Line	:
City	:	OAKWOOD
State	:	OH
Zip	:	45409-1981
Country	:	US
Telephone Number	:	937-395-3656
Fax Number	:	937-395-3657

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	02/04/2022

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Directions to “ HEIDI BUCKINGHAM MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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