Provider Demographics
NPI:1033127626
Name:GERA, RENUKA (MD)
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:
Last Name:GERA
Suffix:
Gender:F
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:B240 LIFE SCIENCE BLDG
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1317
Mailing Address - Country:US
Mailing Address - Phone:517-353-3308
Mailing Address - Fax:
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:STE 145
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5449
Practice Address - Fax:517-364-5409
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010452252080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1589303Medicaid
MI1589303Medicaid
MI0C36092003Medicare PIN