Individual
PAMELA FENNEWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
731 S ILLINOIS ROUTE 21, SUITE 130, GURNEE, IL 60031-3813
(847) 566-3337
(847) 816-3166
Mailing address
731 S ILLINOIS ROUTE 21, SUITE 130, GURNEE, IL 60031-3813
(847) 566-3337
(847) 816-3166
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036057870
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057870
—
IL
01
—
04930281
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/28/2006
Last updated
08/26/2008
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