Provider Demographics
NPI:1821042151
Name:BUCKWALTER, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:BUCKWALTER
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 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1050
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:2001 BUTTERFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1050
Practice Address - Country:US
Practice Address - Phone:630-725-2730
Practice Address - Fax:844-205-5691
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068376L207Q00000X
MDD0075004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDG0518Medicare PIN
VAVVB395AMedicare PIN
MDP01158922Medicare PIN
MDP01158933Medicare PIN
PAG93300Medicare UPIN
MD339LMedicare PIN
MDG01618Medicare PIN
VADR1715Medicare PIN
MD266230YA20Medicare PIN
VAP01242299Medicare PIN
MD26814YAY8Medicare PIN
MDDO6229Medicare PIN