Organization
PAMELLA S GRONEMEYER
Active
Other names
SEMC Pathology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAMELLA SUZZANNE GRONEMEYER MD (SOLE PROPIETOR)
(618) 651-8097
Entity
Organization
Contact information
Practice address
1270 MERCANTILE DR, HIGHLAND, IL 62249
(618) 651-8097
(618) 651-8097
Mailing address
1280 MERCANTILE DR, HIGHLAND, IL 62249-1256
(618) 654-8985
(618) 651-8097
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
207ZP0105X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036043088
—
IL
05
—
036050692
—
IL
05
—
036054213
—
IL
05
—
036057055
—
IL
05
—
036062202
—
IL
05
—
575343394
—
IL
01
—
CK0761
RR MEDICARE PIN
IL
Enumeration date
01/09/2007
Last updated
11/22/2013
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