Healthcare Provider Details

I. General information

NPI: 1366447278
Provider Name (Legal Business Name): KIRSTEN J BUCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 UNIVERSITY DR
MARINETTE WI
54143-4110
US

IV. Provider business mailing address

339 CONSORT DR
BALLWIN MO
63011-4439
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-4200
  • Fax: 715-735-8019
Mailing address:
  • Phone: 636-386-9224
  • Fax: 636-386-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50213
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: