Individual
CAIO DE ANDRADE STAUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 E WASHINGTON ST STE A, INDIANAPOLIS, IN 46204-2609
(317) 963-2610
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01096895A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11022211A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300062710
—
IN
Enumeration date
04/06/2022
Last updated
04/06/2026
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