Provider Demographics
NPI:1306978309
Name:BUCK, ANGELES MICHELLE (DO)
Entity type:Individual
Prefix:
First Name:ANGELES
Middle Name:MICHELLE
Last Name:BUCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELES
Other - Middle Name:MICHELLE
Other - Last Name:LOCKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LN
Practice Address - Street 2:SUITE 601
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-423-9595
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY127009OtherSIHO - WS
KY50034479OtherPASSPORT - WS
KY03118OtherSTATE LICENSE
KY2668570OtherCIGNA-WS
KY000000724271OtherANTHEM -WS
KY0000571200OtherHUMANA - WS
IN201040620Medicaid
KY7100060270Medicaid
KYFB0950091OtherDEA
KY2668570OtherCIGNA-WS
KY50034479OtherPASSPORT - WS