Provider Demographics
NPI:1205095528
Name:BUCHANAN, AMY HAGAN (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:HAGAN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1211 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-4046
Mailing Address - Country:US
Mailing Address - Phone:708-531-5200
Mailing Address - Fax:708-531-7915
Practice Address - Street 1:1211 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-4046
Practice Address - Country:US
Practice Address - Phone:708-531-5200
Practice Address - Fax:708-531-7915
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036120571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine