Healthcare Provider Details

I. General information

NPI: 1881670974
Provider Name (Legal Business Name): AGNES M LAUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AGNES MAGNO

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12680 OLIVE BLVD STE 116
SAINT LOUIS MO
63141-6322
US

IV. Provider business mailing address

12680 OLIVE BLVD STE 116
SAINT LOUIS MO
63141-6322
US

V. Phone/Fax

Practice location:
  • Phone: 314-529-5660
  • Fax: 314-529-5665
Mailing address:
  • Phone: 314-529-5660
  • Fax: 314-529-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35070728L
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024044616
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: