Healthcare Provider Details

I. General information

NPI: 1821071978
Provider Name (Legal Business Name): GUIHUA CAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD
SAINT LOUIS MO
63117-1811
US

IV. Provider business mailing address

PO BOX 795083
SAINT LOUIS MO
63179-0795
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8202
  • Fax: 314-768-7145
Mailing address:
  • Phone: 314-821-8055
  • Fax: 314-821-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2002021161
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: