Provider Demographics
NPI:1841437936
Name:BUCHANAN, DWAYNE BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:BERNARD
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:220 SPRINGFIELD DR STE 210
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2215
Practice Address - Country:US
Practice Address - Phone:630-893-2213
Practice Address - Fax:630-307-0482
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01953171OtherRRM
IL036124946Medicaid
ILF400436681OtherMEDICARE