Provider Demographics
NPI:1164512729
Name:BUCHMANN, JULISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULISSA
Middle Name:
Last Name:BUCHMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULISSA
Other - Middle Name:
Other - Last Name:CORREDOR-BUCHMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 CHILDREN'S WAY
Mailing Address - Street 2:SLOT 512-7
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3510
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:SLOT 512-7
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-33672080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149501001Medicaid
5M484Medicare PIN
AR149501001Medicaid