| Doctor Name: | MICHAEL D BUCKWALTER |
| NPI Number: | 1831486547 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 11016346A |
| Business Practice Address: | 6845 East Us Highway 36 Ste 600 Avon, IN - 461238123 |
| Business Phone Number: | 3172731405 |
| Business Fax Number: | 3172724906 |
| Mailing Address: | 250 N Shadeland Ave, Suite 130 - Provider Enrollment INDIANAPOLIS |
| State: | IN |
| Postal Code: | 462194959 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/01/2011 |
| NPI Last Update Date: | 12/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 11016346A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |