Provider Demographics
NPI:1487725917
Name:GRUESSNER, RAINER W (MD)
Entity type:Individual
Prefix:DR
First Name:RAINER
Middle Name:W
Last Name:GRUESSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-2096
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:750 EAST ADAMS ST
Practice Address - Street 2:STE 2W
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-9535
Practice Address - Fax:315-464-6288
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36718204F00000X
MN33689208600000X
NY280878204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1712215OtherMEDICA - CHOICE
2T096GROtherBLUE CROSS BLUE SHIELD
HP22171OtherHEALTHPARTNERS
IA0977264Medicaid
101022OtherUCARE
AZP00435421OtherRAILROAD MEDICARE
1712215OtherMEDICA - PRIMARY
AZ213545Medicaid
MN690580300Medicaid
MT0060697Medicaid
1009125OtherPREFERREDONE
763592OtherARAZ
101022OtherUCARE
IA0977264Medicaid
AZZ115512Medicare PIN
AZ213545Medicaid