Healthcare Provider Details

I. General information

NPI: 1780822122
Provider Name (Legal Business Name): BAER PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD SUITE 257-C
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

3009 N BALLAS RD SUITE 257-C
SAINT LOUIS MO
63131-2322
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2112
  • Fax: 314-569-1270
Mailing address:
  • Phone: 314-569-2112
  • Fax: 314-569-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTEN M. MENNEMEIER
Title or Position: OWNER
Credential: M.D.
Phone: 314-569-2112