Provider Demographics
NPI:1285164053
Name:GRUNLOH-GUMPENBERGER, DANIELLE SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SUZANNE
Last Name:GRUNLOH-GUMPENBERGER
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:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:636-240-0130
Mailing Address - Fax:636-240-6822
Practice Address - Street 1:300 WINDING WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5081
Practice Address - Country:US
Practice Address - Phone:636-240-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017018655207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology