Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 096005205 | IL |
Y | 213ES0000X | Sports Medicine | 096005205 | IL |
NPI | 1174114144 |
---|---|
Provider Name | Brooke Buchmueller |
First Address | Lebanon, IL 62254-1291 |
Second Address | Lebanon, IL 62254-1291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2021 |
Last Update Date | 01/02/2021 |