Provider Demographics
NPI:1033418454
Name:GRONBACH, LYNN A (DO)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:GRONBACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7642 READING RD STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3204
Mailing Address - Country:US
Mailing Address - Phone:513-246-7796
Mailing Address - Fax:513-810-4400
Practice Address - Street 1:7642 READING RD STE C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3204
Practice Address - Country:US
Practice Address - Phone:513-246-7796
Practice Address - Fax:513-810-4400
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011228207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03251981OtherDOB
OH34.011228OtherOH LICENSE