Provider Demographics
NPI:1457533010
Name:BUCHANAN, MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BUCHANAN
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 1:504 LAUREL HL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1648
Mailing Address - Country:US
Mailing Address - Phone:863-221-1030
Mailing Address - Fax:863-646-9561
Practice Address - Street 1:504 LAUREL HL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1648
Practice Address - Country:US
Practice Address - Phone:863-221-1030
Practice Address - Fax:863-646-9561
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD56659Medicare UPIN
FL53795Medicare PIN