Provider Demographics
NPI:1770564163
Name:ROBERTS, KRIS ANN (DO)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412119
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2119
Mailing Address - Country:US
Mailing Address - Phone:636-561-5437
Mailing Address - Fax:636-561-5100
Practice Address - Street 1:100 BREVCO PLZ
Practice Address - Street 2:STE 101
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1382
Practice Address - Country:US
Practice Address - Phone:636-561-5437
Practice Address - Fax:636-561-5100
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013034100208000000X
IA3134208000000X
AL1035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200009634Medicaid
MO1770564163Medicaid
AL1014776Medicaid
MO1770564163OtherNPI
AL051593356OtherBLUE CROSS/BLUE SHIELD OF AL