Healthcare Provider Details

I. General information

NPI: 1306309208
Provider Name (Legal Business Name): MARTIN CAUPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S 21ST ST STE 400
SAINT LOUIS MO
63103-2267
US

IV. Provider business mailing address

9740 OLD WARSON RD
SAINT LOUIS MO
63124-1484
US

V. Phone/Fax

Practice location:
  • Phone: 314-439-9622
  • Fax:
Mailing address:
  • Phone: 636-734-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: