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NPI Code Detail

MEDICARE: JANELLE ROETHEMEYER M.D.

MEDICARE: JANELLE ROETHEMEYER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician100838MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1127489OTHERMOGHP
20400741OTHERMOUHC
3101014OTHERMOBCBS
4G07379OTHERMOMERCY
54670232OTHERMOAETNA
6000000010034OTHERMOESSENCE
7271716OTHERMOHEALTHLINK

General Provider Information

NPI Number : 1417938929
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANELLE ROETHEMEYER M.D.
Provider Business Mailing Address
First Line : PO BOX 959354
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-8509
Country : US
Telephone Number : 314-996-7080
Fax Number : 314-996-7658
Provider Business Practice Location Address
First Line : 3844 S LINDBERGH BLVD STE 120
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63127-1369
Country : US
Telephone Number : 314-525-0490
Fax Number : 314-525-0434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 09/19/2025

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