Individual
DR. JURGEN GERNOT RUNSCHKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
630 KENMOOR AVE SE STE 105, GRAND RAPIDS, MI 49546-8626
(616) 204-5698
Mailing address
7091 E SHORE RD, TRAVERSE CITY, MI 49686-1827
(616) 204-5698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01092546A
IN
207P00000X
Emergency Medicine Physician
321283
NY
207P00000X
Emergency Medicine Physician
4301080098
MI
207P00000X
Emergency Medicine Physician
65288
MN
208600000X
Surgery Physician
4301080098
MI
2086S0129X
Vascular Surgery Physician
Primary
4301080098
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104806285
—
MI
05
—
104951052
—
MI
01
—
JR080098
BCBS
MI
Enumeration date
06/02/2006
Last updated
03/12/2024
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