Provider Demographics
NPI:1124608278
Name:BUCHENIC, MICHAEL JOHN IV (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BUCHENIC
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TOWN CENTER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8312
Mailing Address - Country:US
Mailing Address - Phone:330-482-3871
Mailing Address - Fax:330-482-0133
Practice Address - Street 1:400 TOWN CENTER AVE STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8312
Practice Address - Country:US
Practice Address - Phone:330-482-3871
Practice Address - Fax:330-482-0133
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34017528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty