Individual
THEODORE J KAPANJIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
13100 MANCHESTER RD STE 250, SAINT LOUIS, MO 63131-1729
(314) 543-4015
(206) 363-7335
Mailing address
13100 MANCHESTER RD STE 250, SAINT LOUIS, MO 63131-1729
(314) 543-4015
(206) 363-7335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2021041951
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1110KA
REGENCE RIDER
WA
01
—
2021041951
MISSOURI STATE MEDICAL LICENSE
MO
01
—
2500081499
MISSOURI BUREAU OF NARCOTICS AND DANGEROUS DRUGS
MO
01
—
P00956630
MEDICARE RR
—
Enumeration date
10/26/2006
Last updated
09/15/2023
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