Organization
HANNIBAL CLINIC OPERATIONS, L.L.C
Active
Other names
Hannibal Clinic, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BUKSTEIN MD (PHYSICIAN EXEC. DIRECTOR)
(573) 231-3172
Entity
Organization
Contact information
Practice address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 221-5250
(573) 231-3706
Mailing address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 221-5250
(573) 231-3706
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000013772
PTAN
MO
05
—
500221007
—
MO
Enumeration date
01/11/2006
Last updated
04/18/2022
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