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General NPI Number Information
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NPI Number | 1194874966
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Entity Type | Organization
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Legal Business Name | PAMELLA S GRONEMEYER
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 1270 MERCANTILE DR
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City | HIGHLAND
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State | IL
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Zip | 62249
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Country | US
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Telephone | 618-651-8097
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Fax | 618-651-8097
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Provider Business Mailing Address
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Address Line | 1280 MERCANTILE DR
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City | HIGHLAND
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State | IL
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Zip | 62249-1256
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Country | US
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Telephone | 618-654-8985
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Fax | 618-651-8097
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Authorized Official
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Title or Position | SOLE PROPIETOR
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Name | DR. PAMELLA SUZZANNE GRONEMEYER
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Credential | MD
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Telephone | 618-651-8097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 207ZP0105X
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License Number State | IL
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