Provider Demographics
NPI:1497982847
Name:BUCKMAN, DONALD M (PH D)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:BUCKMAN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1741
Mailing Address - Country:US
Mailing Address - Phone:224-325-5436
Mailing Address - Fax:618-273-2808
Practice Address - Street 1:1910 4TH ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1741
Practice Address - Country:US
Practice Address - Phone:224-325-5436
Practice Address - Fax:618-273-2808
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009325103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660631Medicaid