Provider Demographics
NPI:1407878473
Name:RENKE, CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:RENKE
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 1:72760 EL PASEO STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3301
Mailing Address - Country:US
Mailing Address - Phone:760-776-8444
Mailing Address - Fax:760-776-8440
Practice Address - Street 1:72760 EL PASEO STE 1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3301
Practice Address - Country:US
Practice Address - Phone:760-776-8444
Practice Address - Fax:760-776-8440
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C503281Medicare ID - Type Unspecified
H09694Medicare UPIN