MEDICARE: ALICE BUCKLEY 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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	01080469A	IN
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	E4648	AR

General Provider Information

NPI Number	:	1659359891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE BUCKLEY M.D.

Provider Business Mailing Address
First Line	:	1513 IRONWOOD DR
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-1564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3728 S REED RD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-3829
Country	:	US
Telephone Number	:	765-626-7110
Fax Number	:

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	03/27/2026

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