IndividualActive
Andrew Ninichuck, M.D.
NPI 1609841956 · General Practice Physician · Bonne Terre, MO
Provider details
- NPI number
- 1609841956
- Entity type
- Individual
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 102387 (MO)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
527 Benham St
Bonne Terre, MO 63628-1205
Phone: (573) 358-9119
Fax: (573) 358-9489
Approximate (ZIP-level) locationGet directions
Mailing address
527 Benham St
Bonne Terre, MO 63628-1205
Registry dates
- Enumerated
- 2006-02-21
- Last updated
- 2015-11-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.