Provider Demographics
NPI:1245258706
Name:GROENER, RUSSELL JOHN LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JOHN LOUIS
Last Name:GROENER
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:800-862-9980
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DEPT ANESTHESIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:800-862-9980
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008022987207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205817208Medicaid
ILENROLLEDMedicaid
MO050086072Medicare PIN
IL$$$$$$$$$Medicaid
GA003128483AMedicaid
OK200240840AMedicaid
MO101740059Medicare PIN
LA2197509Medicaid
MO101740059Medicaid
FL917779000Medicaid
TN1513425Medicaid
MI1245258706Medicaid
AR177448001Medicaid
KS200620700AMedicaid