Provider Demographics
NPI:1245211945
Name:MUCHNICK, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MUCHNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COUNTRY CLUB TERRACE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4650
Mailing Address - Country:US
Mailing Address - Phone:314-420-2631
Mailing Address - Fax:
Practice Address - Street 1:4 COUNTRY CLUB TER
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4650
Practice Address - Country:US
Practice Address - Phone:314-420-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA09918Medicare UPIN
MO110114092Medicare PIN
MO007012451Medicare PIN
MO0400064OtherUHC
MO4040589OtherAETNA
MO110114092Medicare PIN
MO000000010026OtherESSENCE
MO20986OtherBCBS
MO109912OtherHEALTHLINK
MO007012451Medicare PIN