Provider Demographics
NPI:1942285010
Name:GRONEMEYER, PAMELLA S (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELLA
Middle Name:S
Last Name:GRONEMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 MERCANTILE DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1256
Mailing Address - Country:US
Mailing Address - Phone:618-654-8985
Mailing Address - Fax:618-651-8097
Practice Address - Street 1:1270 MERCANTILE DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1256
Practice Address - Country:US
Practice Address - Phone:618-651-8097
Practice Address - Fax:618-651-8097
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062202207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062202-2Medicaid
MO1726OtherBCBS
IL8215239OtherBCBS
MO1726OtherBCBS
IL036062202-2Medicaid
ILC42995Medicare UPIN