Provider Demographics
NPI:1841242450
Name:BUESCHER, KEITH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:L
Last Name:BUESCHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 GREENBRIAR DR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6425
Mailing Address - Country:US
Mailing Address - Phone:217-546-3118
Mailing Address - Fax:217-546-3184
Practice Address - Street 1:2921 GREENBRIAR DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6425
Practice Address - Country:US
Practice Address - Phone:217-546-3118
Practice Address - Fax:217-546-3184
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL064594OtherHEALTH ALLIANCE
IL5605298OtherAETNA
IL160279 (MHS)OtherVALUE OPTIONS
IL282605OtherHEALTHLINK
IL160279 (MHS)OtherVALUE OPTIONS