Provider Demographics
NPI:1871795955
Name:BRUNO, KRISTEN INGRID (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:INGRID
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1181 LOCKETT RD
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4234
Mailing Address - Country:US
Mailing Address - Phone:314-258-5941
Mailing Address - Fax:
Practice Address - Street 1:706 N MAIN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1743
Practice Address - Country:US
Practice Address - Phone:314-258-5941
Practice Address - Fax:314-279-0255
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007007759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205547201Medicaid