MEDICARE: AGNES M LAUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35070728L	OH
2	208000000X	Pediatrics Physician	2024044616	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	510450201027	OTHER	CARESOURCE
3	000000323677	OTHER	ANTHEM

General Provider Information

NPI Number	:	1881670974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES M LAUS MD

Provider Business Mailing Address
First Line	:	12680 OLIVE BLVD STE 116
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6322
Country	:	US
Telephone Number	:	314-529-5660
Fax Number	:	314-529-5665

Provider Business Practice Location Address
First Line	:	12680 OLIVE BLVD STE 116
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6322
Country	:	US
Telephone Number	:	314-529-5660
Fax Number	:	314-529-5665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	04/02/2025

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Directions to “ AGNES M LAUS MD” Practice Location

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