Organization
BASSO FAMILY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS KIPP BASSO DPM (CHIEF OFFICER)
(618) 578-8667
Entity
Organization
Contact information
Practice address
2821 N BALLAS RD STE C15, SAINT LOUIS, MO 63131-2300
(314) 394-8580
(314) 983-9650
Mailing address
4105 ENDICOTT CT, SWANSEA, IL 62226-8210
(618) 578-8667
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Enumeration date
04/30/2022
Last updated
11/06/2023
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