Provider Demographics
NPI:1164872172
Name:BUIKEMA, EVAN ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ROBERT
Last Name:BUIKEMA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LINCOLN WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-7595
Mailing Address - Country:US
Mailing Address - Phone:515-239-4410
Mailing Address - Fax:515-663-4885
Practice Address - Street 1:3600 LINCOLN WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7595
Practice Address - Country:US
Practice Address - Phone:515-239-4410
Practice Address - Fax:515-663-4885
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016700103TC0700X
IA090735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical