Fennewald, Pamela

Fennewald, Pamela is an individual health care provider with primary practice located at 731 S Illinois Route 21 Suite 130, Gurnee IL 60031-3813. She recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as her primary health care specialty. Fennewald, Pamela can be contacted via phone (847) 566-3337.

Contact Information

Primary practice address
731 S Illinois Route 21 Suite 130 Gurnee IL 60031-3813
Phone: (847) 566-3337
Fax: (847) 816-3166
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X 036057870 Illinois

Profile Details

NPI number 1912911991
LBN Legal business name Fennewald, Pamela
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2006
Last updated Aug 26th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1912911991 NPPES
Illinois MEDICAID 036057870
Illinois Other 04930281

Popular Providers