Provider Demographics
NPI:1043413842
Name:MENNEMEIER, KRISTEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:M
Last Name:MENNEMEIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3009 N. BALLAS RD.
Mailing Address - Street 2:SUITE 257C
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-569-2112
Mailing Address - Fax:314-569-1270
Practice Address - Street 1:3009 N. BALLAS RD.
Practice Address - Street 2:SUITE 257C
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2308
Practice Address - Country:US
Practice Address - Phone:314-569-2112
Practice Address - Fax:314-569-1270
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015655208000000X
MO2008029936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics