Healthcare Provider Details

I. General information

NPI: 1295112076
Provider Name (Legal Business Name): NICHOLAS KAUP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST
SAINT JOSEPH MO
64506
US

IV. Provider business mailing address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6350
  • Fax: 816-271-6753
Mailing address:
  • Phone: 816-271-6350
  • Fax: 816-271-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9408555
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2019023494
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: