MEDICARE: MICHAEL D BUCKWALTER 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	390200000X	Student in an Organized Health Care Education/Training Program	11016346A	IN
2	207Q00000X	Family Medicine Physician	01073529A	IN

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	:	1831486547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D BUCKWALTER MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	SUITE 130 - PROVIDER ENROLLMENT
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6845 EAST US HIGHWAY 36
Second Line	:	STE 600
City	:	AVON
State	:	IN
Zip	:	46123-8123
Country	:	US
Telephone Number	:	317-273-1405
Fax Number	:	317-272-4906

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	12/24/2014

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