Provider Demographics
NPI:1871689356
Name:CAUDILL, CHADWICK T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:T
Last Name:CAUDILL
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:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-287-6908
Mailing Address - Fax:636-937-8995
Practice Address - Street 1:1400 HIGHWAY 61 S.
Practice Address - Street 2:STE 340
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4141
Practice Address - Country:US
Practice Address - Phone:636-937-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H04268Medicare UPIN