Healthcare Provider Details

I. General information

NPI: 1740249911
Provider Name (Legal Business Name): LAURA J. KROUPA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

222 CRANDON DR
SAINT LOUIS MO
63105-3608
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-289-7676
  • Fax: 314-289-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR7N27
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: