Individual
MITCHELL RAY BUERCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2937 S BRENTWOOD BLVD, BRENTWOOD, MO 63144-2713
(314) 961-3804
Mailing address
4940 GRANITE DR, SMITHTON, IL 62285-3635
(618) 719-4006
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2024031307
MO
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
815976827
UNITED HEALTHCARE
MO
Enumeration date
03/06/2019
Last updated
08/18/2024
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