Provider Demographics
NPI:1134185150
Name:BUECKER, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:BUECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4331 CHURCHMAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1164
Mailing Address - Country:US
Mailing Address - Phone:502-364-0902
Mailing Address - Fax:502-364-0099
Practice Address - Street 1:4331 CHURCHMAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1164
Practice Address - Country:US
Practice Address - Phone:502-364-0902
Practice Address - Fax:502-364-0099
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY35801207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50101088OtherPASSPORT HEALTH PLAN
KYP01572803OtherRAILROAD MEDICARE
000000995097OtherANTHEM
KY7556710OtherAETNA PROVIDER NUMB
KY64104680Medicaid
KYI36187Medicare UPIN
ININ2105007Medicare PIN
KY7556710OtherAETNA PROVIDER NUMB
KY50101088OtherPASSPORT HEALTH PLAN
KYP400026718Medicare PIN
KYI36187Medicare UPIN
KYK135280Medicare PIN
KY000000378925OtherANTHEM PROVIDER NUMB
KY50028955OtherPASSPORT & PASSPORT ADVANTAGE - NOTC
KYP400026718Medicare PIN
KY0299023Medicare PIN