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General NPI Number Information
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NPI Number | 1124769781
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Entity Type | Individual
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Provider Name | CAIO DE ANDRADE STAUT
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Gender | Male
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 07/20/2025
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Provider Practice Location Address
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Address Line | 10122 E 10TH ST STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-2697
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Country | US
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Telephone | 317-355-5717
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Fax |
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Provider Business Mailing Address
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Address Line | 980 INDIANA AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2915
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Country | US
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Telephone | 317-278-0300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 11022211A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 01096895A
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License Number State | IN
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