Individual
MR. ANDREW JOHN NINICHUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
527 BENHAM ST, BONNE TERRE, MO 63628-1205
(573) 358-9119
(573) 358-9489
Mailing address
527 BENHAM ST, BONNE TERRE, MO 63628-1205
(573) 358-9119
(573) 358-9489
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
102387
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609841956
—
MO
Enumeration date
02/21/2006
Last updated
11/10/2015
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