Provider Demographics
NPI:1629034244
Name:WERNER, REBECCA L (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:WERNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:906-632-5276
Practice Address - Street 1:4285 PARKWAY PLACE DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2385
Practice Address - Country:US
Practice Address - Phone:616-252-4300
Practice Address - Fax:616-252-4396
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4230608Medicaid
MI4467618Medicaid
MI080A760010OtherBCBS
MI4230608Medicaid
OA76001029Medicare ID - Type Unspecified