Provider Demographics
NPI:1326355348
Name:CHANDRA S. KAUP,M.D.,P.C.
Entity Type:Organization
Organization Name:CHANDRA S. KAUP,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-830-5233
Mailing Address - Street 1:1224 GRAHAM RD
Mailing Address - Street 2:SUITE 2006
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-830-5233
Mailing Address - Fax:314-830-5225
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:SUITE 2006
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-830-5233
Practice Address - Fax:314-830-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE12106Medicare UPIN
MO000003810Medicare PIN