Healthcare Provider Details

I. General information

NPI: 1154347466
Provider Name (Legal Business Name): FRANZ J WIPPOLD II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1016
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8131
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7200
  • Fax: 314-747-4189
Mailing address:
  • Phone: 314-362-7200
  • Fax: 314-747-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberR2C83
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: