Provider Demographics
NPI:1386358042
Name:BARTUSCH, CLAIRE (PA)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:BARTUSCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:636-549-0121
Mailing Address - Fax:636-549-0122
Practice Address - Street 1:20 THE LEGENDS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3825
Practice Address - Country:US
Practice Address - Phone:636-549-0121
Practice Address - Fax:636-549-0122
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1216926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant