Provider Demographics
NPI:1770664856
Name:BUCHER, GARY G (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:G
Last Name:BUCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3023 N CLARK ST # 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5200
Mailing Address - Country:US
Mailing Address - Phone:773-327-1600
Mailing Address - Fax:773-327-6622
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:312-623-2625
Practice Address - Fax:773-289-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-087460207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622085OtherBLUE CROSS BLUE SHEILD
K35189Medicare PIN
IL1622085OtherBLUE CROSS BLUE SHEILD