Healthcare Provider Details

I. General information

NPI: 1245493402
Provider Name (Legal Business Name): SIDDHARTH KAUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 DE PAUL DR STE 100
BRIDGETON MO
63044-2541
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-738-2770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2012009717
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125-055311
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD221827
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberU3562
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME161484
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME161484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: