Individual
THERESA T. RICKELMAN
Active
Individual
THERESA T. RICKELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
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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