Healthcare Provider Details

I. General information

NPI: 1639604796
Provider Name (Legal Business Name): AARON COPUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD M260
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

3000 WOODHAVEN CIR
VESTAVIA AL
35243-1829
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-9851
  • Fax:
Mailing address:
  • Phone: 248-376-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301508276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: