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General NPI Number Information
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NPI Number | 1366447278
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Entity Type | Individual
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Provider Name | KIRSTEN J BUCK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 3003 UNIVERSITY DR
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City | MARINETTE
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State | WI
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Zip | 54143-4110
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Country | US
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Telephone | 715-735-4200
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Fax | 715-735-8019
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Provider Business Mailing Address
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Address Line | 339 CONSORT DR
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City | BALLWIN
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State | MO
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Zip | 63011-4439
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Country | US
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Telephone | 636-386-9224
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Fax | 636-386-7679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 50213
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License Number State | WI
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