Individual
DR. MICHAEL RENICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3109 BIENVILLE BLVD, OCEAN SPRINGS, MS 39564-4361
(228) 818-1111
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MS13095
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00113599
—
MS
05
—
009928125
—
AL
01
—
646000515
BLUE CROSS OF MS
—
01
—
930048428
MEDICARE RAILROAD
—
Enumeration date
01/12/2007
Last updated
07/08/2007
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