Provider Demographics
NPI:1972529014
Name:RENEKER, ROBERT E JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:RENEKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 228
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:2373 64TH ST SW
Practice Address - Street 2:STE 1200
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315
Practice Address - Country:US
Practice Address - Phone:616-685-3910
Practice Address - Fax:616-685-3923
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRR063893207Q00000X
MI4301063893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP61260OtherBCN
MI4445844Medicaid
MI080D16151OtherBXBS
MI4445844Medicaid
MIOP32930420Medicare PIN
MIG42758Medicare UPIN