Provider Demographics
NPI:1912085416
Name:BUCHANAN, TIMOTHY GEORGE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GEORGE
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 15TH AVE
Mailing Address - Street 2:#180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:262-827-2959
Mailing Address - Fax:262-826-2948
Practice Address - Street 1:14555 W NATIONAL AVE
Practice Address - Street 2:#165
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4497
Practice Address - Country:US
Practice Address - Phone:262-827-2959
Practice Address - Fax:262-827-2948
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30619200Medicaid
WI68015-0003Medicare PIN