MEDICARE: ANDREW SCADUTO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R9931	MO

General Provider Information

NPI Number	:	1659367704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SCADUTO MD

Provider Business Mailing Address
First Line	:	PO BOX 240244
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63024-0244
Country	:	US
Telephone Number	:	314-546-5808
Fax Number	:	314-677-6807

Provider Business Practice Location Address
First Line	:	8112 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3736
Country	:	US
Telephone Number	:	314-546-5808
Fax Number	:	314-677-6807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	02/16/2010

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