Individual
THEODORE NMI KORECKIJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-5633
(573) 426-5314
Mailing address
1050 W 10TH ST, ATTN; EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS, ROLLA, MO 65401-2905
(573) 364-9000
(573) 426-2108
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME94881
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200012334
RAILROAD MEDICARE
—
05
—
201445004
—
MO
01
—
21397
BLUE CROSS
—
Enumeration date
10/04/2006
Last updated
04/11/2018
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