Alexandra Buckwalter, MD
Individual provider Active NPI Family Medicine Physician · Dixon, IL
NPI 1750138939 · NPPES record last updated Oct 14, 2024
Key facts
- NPI
- 1750138939
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 125084151 (IL)
- Practice address
- 102 S Hennepin Ave
Dixon, IL 61021-3013 - Phone
- (815) 285-8520
- NPI assigned
- May 4, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125084151 | IL | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 125084151 | IL | Yes |
Addresses
Primary practice location
102 S Hennepin Ave
Dixon, IL 61021-3013
Mailing address
102 S Hennepin Ave
Dixon, IL 61021-3013
Other providers in Dixon, IL
- Lyn Brokaw
- Tanya Marie Brooks
- Auben Brown
- Jennifer Christine Bubrick
- Melissa Buckley
- Katie Buls
- Kelly L Burrow
- Aaron Buser
- Misty Dawn Buskohl
- Kevin M Buss
All providers in Dixon, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.