Provider Demographics
NPI:1619939493
Name:BUENCAMINO, AMY C P (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:C P
Last Name:BUENCAMINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:PIVOVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4410 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4901
Mailing Address - Country:US
Mailing Address - Phone:608-233-9746
Mailing Address - Fax:608-233-0026
Practice Address - Street 1:4410 REGENT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4901
Practice Address - Country:US
Practice Address - Phone:608-233-9746
Practice Address - Fax:608-233-0026
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46409-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34510600Medicaid
WI34510600Medicaid