Provider Demographics
NPI:1063714459
Name:BUIKEMA, TOVAH ANN (DO)
Entity type:Individual
Prefix:MRS
First Name:TOVAH
Middle Name:ANN
Last Name:BUIKEMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:TOVAH
Other - Middle Name:ANN
Other - Last Name:THOMASINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:
Practice Address - Street 1:611 W. PARK ST.
Practice Address - Street 2:MATERNAL-FETAL MEDICINE
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-4930
Practice Address - Fax:217-383-4014
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142207207VM0101X
NE1420207VM0101X
IN02005661A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine