MEDICARE: DR. MICHAEL J RENSCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	43232	MN
2	207R00000X	Internal Medicine Physician	43232	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00244346	OTHER		RR MEDICARE
6	00RM40	OTHER	TX	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	132562	OTHER	MN	UCARE
3	HP47841	OTHER	MN	HEALTH PARTNERS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2900408	OTHER	MN	MEDICA
7	053038	OTHER		IOWA MA
8	41084933956001C224	OTHER		CHAMPUS TRICARE
9	638R4RE	OTHER	MN	BCBS
10	1042781	OTHER	MN	PREFERRED ONE
11	2316539	OTHER	MN	AMERICAS PPO

General Provider Information

NPI Number	:	1366446023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J RENSCH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 290647
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78029-0647
Country	:	US
Telephone Number	:	507-995-0537
Fax Number	:	830-257-0049

Provider Business Practice Location Address
First Line	:	420 WATER ST
Second Line	:	SUITE 103
City	:	KERRVILLE
State	:	TX
Zip	:	78028-5200
Country	:	US
Telephone Number	:	830-496-0111
Fax Number	:	830-257-0049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	03/04/2013

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