BRADLEY W. BUCKROP DPM (NPI# 1205071149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205071149 |
| Entity Type | Organization |
| Organization Name | BRADLEY W. BUCKROP DPM |
| Practice Address |
3727 46th Ave Suite 103 Rock Island IL 61201-7078 |
| Practice Telephone | 3097883668 |
| Practice Fax Number | 3097865168 |
| Mailing Telephone | 3097883668 |
| Mailing Fax Number | 3097865168 |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2008-12-17 |
| Authorized Official Name | BRADLEY WILLIAM BUCKROP (PODIATRIST/OWNER) |
| Authorized Official Telephone | 3097883668 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
00545 | IA | Podiatric Medicine & Surgery Service Providers |
| Y | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
01600458 | IL | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 016004658 | 05 | |
| DEA | BB3472711 | 01 | |
| IL | BLUE CROSS BLUE SHILD | 8182069 | 01 |
| Street Address |
3727 46TH AVE SUITE 103 |
| City | ROCK ISLAND |
| State | IL |
| Zip Code | 61201-7078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689206245 | Judy Kay Moore | Technician | 2439 8th Ave, Rock Island, IL 61201 | 2020-02-11 |
| 1053956862 | Christina Beam | Counselor | 1413 40th Street, Rock Island, IL 61201 | 2019-11-15 |
| 1356843817 | Stephanie Kaye Jones | Counselor | 2701 17th St., Rock Island, IL 61201 | 2018-03-01 |
| 1073062030 | Innovative Transport Enterprise, LLC | Non-emergency Medical Transport (VAN) | 2239 24th Street Apt 15c, Rock Island, IL 61201 | 2016-09-30 |
| 1124575733 | Robert Young Center | Community Based Residential Treatment Facility, Mental Illness | 2701 - 17 Street, Rockisland, IL 61201 | 2016-09-01 |
| 1538520903 | James Keith Frainey | Psychologist | 805 19th Street, Transitions Mhs, Rock Island, IL 61201 | 2016-03-14 |
| 1417340837 | Brandon Lee Sachwitz | Physician Assistant | 2701 17th Street, Trinity Medical Center, Rock Island, IL 61201 | 2015-03-10 |
| 1215366679 | Kimberly Lyall | Physical Therapy Assistant | 767 30th Street, Rock Island, IL 61201 | 2013-11-06 |
| 1386080745 | The Abbey Center, LLC | Clinic/Center | 3031 5th Ave., Rock Island, IL 61201 | 2013-05-13 |
| 1487097382 | Joe Lee Westerhof | Veterinarian | 2529 11th St, Rock Island, IL 61201 | 2013-04-10 |
| Find all providers in zip 61201 | ||||
| Taxonomy Code | 213EP1101X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Primary Podiatric Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558476739 | Bradley William Buckrop | Podiatrist | 3727 46th Avenue Blackhawk Rd, Ste 103, Rock Island, IL 61201-7078 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558703298 | Audey Nasser | Podiatrist | 1475 E Belvidere Rd Ste 202, Grayslake, IL 60030-2015 | 2013-07-23 |
| 1588008692 | Podiatry Care, Inc | Podiatrist | 832 Old Checker Rd, Buffalo Grove, IL 60089-1689 | 2013-04-19 |
| 1952600058 | Magdala Danielle Lafontant | Podiatrist | 6374 N Lincoln Ave Ste 205, Chicago, IL 60659-1283 | 2011-03-15 |
| 1679760821 | Foot and Ankle Inc | Podiatrist | 14539 S Stirrup Ct, Homer Glen, IL 60491-9297 | 2007-10-02 |
| 1255548202 | Dr. Robert L. Baron | Podiatrist | 60 Main St., Suite A, Oswego, IL 60543-8594 | 2007-05-17 |
| 1780801548 | Edgewater Beach Foot and Ankle Center, P.C. | Podiatrist | 5331 N Sheridan Rd, Chicago, IL 60640-2531 | 2007-04-20 |
| 1841310760 | Jeffrey Garrard | Podiatrist | 6225 Dempster St, Morton Grove, IL 60053-2818 | 2007-04-02 |
| 1255468054 | Michael Anthony Walsh | Podiatrist | 9806 Grand Ave, Franklin Park, IL 60131-2679 | 2007-02-27 |
| 1659407781 | Martin Bruce Nead | Podiatrist | 1014 E St, Charleston, IL 61920-2524 | 2007-02-25 |
| 1821123977 | Brian J Reilly | Podiatrist | 2402 E Oakland Ave, Suite 5, Bloomington, IL 61701-5828 | 2007-02-22 |
| Find all providers with the same taxonomy | ||||
| City | ROCK ISLAND |
| Zip Code | 61201 |
Please comment or provide details below to improve the information on BRADLEY W. BUCKROP DPM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.