Healthcare Provider Details

I. General information

NPI: 1710187992
Provider Name (Legal Business Name): ANDREA ADAMS KAUPAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 36TH STREET
VERO BEACH FL
32960-6574
US

IV. Provider business mailing address

1265 36TH STREET
VERO BEACH FL
32960-6574
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-6340
  • Fax: 772-567-3564
Mailing address:
  • Phone: 772-567-6340
  • Fax: 772-567-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101017425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: