MEDICARE: DR. KRISTEN M MENNEMEIER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2006015655	MO
2	208000000X	Pediatrics Physician	2008029936	MO

General Provider Information

NPI Number	:	1043413842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN M MENNEMEIER M.D.

Provider Business Mailing Address
First Line	:	3009 N. BALLAS RD.
Second Line	:	SUITE 257C
City	:	ST. LOUIS
State	:	MO
Zip	:	63131-2322
Country	:	US
Telephone Number	:	314-569-2112
Fax Number	:	314-569-1270

Provider Business Practice Location Address
First Line	:	3009 N. BALLAS RD.
Second Line	:	SUITE 257C
City	:	ST. LOUIS
State	:	MO
Zip	:	63131-2308
Country	:	US
Telephone Number	:	314-569-2112
Fax Number	:	314-569-1270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	12/29/2011

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