Provider Demographics
NPI:1366447278
Name:BUCK, KIRSTEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:J
Last Name:BUCK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-386-7679
Practice Address - Street 1:3003 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4110
Practice Address - Country:US
Practice Address - Phone:715-735-4200
Practice Address - Fax:715-735-8019
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-11-29
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Provider Licenses
StateLicense IDTaxonomies
WI50213207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366447278Medicaid
WI1366447278Medicaid
MO205916505Medicaid