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Individual

THERESA T. RICKELMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
615 S NEW BALLAS RD DEPT OF, SAINT LOUIS, MO 63141-8221
(636) 386-9224
(636) 386-7679
Mailing address
339 CONSORT DR, BALLWIN, MO 63011-4439
(636) 386-9224
(636) 386-7679

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2001014679
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0976845
IA
05
207178708
MO
01
80174
HEALTHCARE USA
MO
01
8298
HEALTHCARE USA (GROUP)
MO
01
CG4336
RAILROAD MEDICARE
01
P00130500
RAILROAD
Enumeration date
07/19/2006
Last updated
03/13/2018
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