Provider Demographics
NPI:1144293697
Name:KAPP, MARYBETH ESSWEIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARYBETH
Middle Name:ESSWEIN
Last Name:KAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3065 WILLIAM ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6393
Mailing Address - Country:US
Mailing Address - Phone:573-334-7427
Mailing Address - Fax:573-334-5970
Practice Address - Street 1:3065 WILLIAM ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6393
Practice Address - Country:US
Practice Address - Phone:573-334-7427
Practice Address - Fax:573-334-5970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR2K43207W00000X
KY32049207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64444359Medicaid
KY64444359Medicaid
KY1793101Medicare ID - Type Unspecified