Provider Demographics
NPI:1730115817
Name:BUCHWALD, HENRY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:BUCHWALD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 195
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-1400
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FIRST FLOOR, CLINIC 1E
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15522208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0505974Medicaid
MN101549OtherUCARE
ND10757Medicaid
MN1008998OtherPREFERRED ONE
MN2T086BUOtherBCBS
WI31263900Medicaid
MN17-24583OtherMEDICA CHOICE
MN768045OtherARAZ
SD7762290Medicaid
MN496278800Medicaid
MNHP22137OtherHEALTHPARTNERS
MN17-00026OtherMEDICA PRIMARY
WI31263900Medicaid
MN496278800Medicaid
SD7762290Medicaid
MNHP22137OtherHEALTHPARTNERS