Provider Demographics
NPI:1730964537
Name:KAUPP, CALEB JOSEPH (EMT)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:JOSEPH
Last Name:KAUPP
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61744-7725
Mailing Address - Country:US
Mailing Address - Phone:309-825-6812
Mailing Address - Fax:309-747-2825
Practice Address - Street 1:105 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:IL
Practice Address - Zip Code:61744-7725
Practice Address - Country:US
Practice Address - Phone:309-747-2699
Practice Address - Fax:309-747-2825
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060647781146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic