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:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25592
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6951
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:708-424-5001
Practice Address - Street 1:5914 WOLFPEN PLEASANT HILL RD STE E
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-3078
Practice Address - Country:US
Practice Address - Phone:513-831-7503
Practice Address - Fax:513-831-7923
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2025-09-12
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
OH34.011228OtherOH LICENSE
CA03251981OtherDOB