Individual
BURT I. BROMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
621 S NEW BALLAS RD, SUITE 198-A, SAINT LOUIS, MO 63141-8232
(314) 251-6777
(314) 251-5859
Mailing address
621 S NEW BALLAS RD, SUITE 198-A, SAINT LOUIS, MO 63141-8232
(314) 251-6777
(314) 251-5859
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
MD2020-0088
NM
2080P0202X
Pediatric Cardiology Physician
R9H67
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202593737
—
MO
Enumeration date
08/24/2006
Last updated
02/27/2020
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