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Contact Information

GREGG BANTRUP, MD
300 1ST CAPITOL DR
SAINT CHARLES, MO63301-2844
 Phone: 314-989-3000
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for GREGG BANTRUP · (Male)

NPI # 1215986435
Status Active
Credentials MD
Entity Individual
Enumeration date 05/06/2006
Last updated 05/02/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • MO License # 108695
  • MO Medicaid 208042010
  • MO Other P00139813 RR MEDICARE
Hospital affiliation(s)
  • SSM ST JOSEPH HEALTH CENTER - (Acute Care)
    300 1ST CAPITOL DR
    SAINT CHARLES, MO 63301
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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