Healthcare Provider Details

I. General information

NPI: 1457466104
Provider Name (Legal Business Name): SUSAN BROMBERG SCHNEIDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S WOODS MILL RD SUITE 750
CHESTERFIELD MO
63017-3625
US

IV. Provider business mailing address

222 S WOODS MILL RD SUITE 750
CHESTERFIELD MO
63017-3625
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6600
  • Fax: 314-434-5939
Mailing address:
  • Phone: 314-205-6600
  • Fax: 314-434-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberR2B98
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: