Provider Demographics
NPI:1568402303
Name:BUCHSBAUM, JEFFREY C (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:BUCHSBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2425 N MILO B SAMPSON LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1398
Practice Address - Country:US
Practice Address - Phone:812-349-5074
Practice Address - Fax:812-349-5046
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4256772085R0001X
FLME1036492085R0001X
IN01068408A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200387620Medicaid
KY64053242Medicaid
AKMD002INMedicaid
INP01420753OtherRAILROAD MEDICARE
INP01420753OtherRAILROAD MEDICARE
INM400025483Medicare PIN