Provider Demographics
NPI:1285612010
Name:BUETIKOFER, JEFFREY A (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:BUETIKOFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4604
Mailing Address - Country:US
Mailing Address - Phone:814-453-7767
Mailing Address - Fax:814-454-6667
Practice Address - Street 1:2315 MYRTLE STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4604
Practice Address - Country:US
Practice Address - Phone:814-453-7767
Practice Address - Fax:814-454-6667
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041659L207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012063690007Medicaid
PA0012063690007Medicaid
PAE02455Medicare UPIN
PA603894Medicare ID - Type Unspecified