Healthcare Provider Details

I. General information

NPI: 1174739122
Provider Name (Legal Business Name): GRETCHEN L. CROMER, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 41ST ST
MOLINE IL
61265-7830
US

IV. Provider business mailing address

3302 41ST ST
MOLINE IL
61265-7830
US

V. Phone/Fax

Practice location:
  • Phone: 309-764-3912
  • Fax: 309-736-1804
Mailing address:
  • Phone: 309-764-3912
  • Fax: 309-736-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name: GRETCHEN L CROMER
Title or Position: PRESIDENT
Credential: MD
Phone: 309-764-3912