Provider Demographics
NPI:1780678375
Name:SIPPEL, CARL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JEFFREY
Last Name:SIPPEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FOX MDWS
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1448
Mailing Address - Country:US
Mailing Address - Phone:314-729-7615
Mailing Address - Fax:
Practice Address - Street 1:3530 JEFFCO BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6101
Practice Address - Country:US
Practice Address - Phone:636-461-2142
Practice Address - Fax:636-461-2146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR2F08208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE58599Medicare UPIN