Healthcare Provider Details

I. General information

NPI: 1417938929
Provider Name (Legal Business Name): JANELLE ROETHEMEYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 S LINDBERGH BLVD STE 120
SAINT LOUIS MO
63127-1369
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-8509
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-0490
  • Fax: 314-525-0434
Mailing address:
  • Phone: 314-996-7080
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number100838
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: