Provider Demographics
NPI:1902393721
Name:RENECLE, MICHAEL DOMINIC (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOMINIC
Last Name:RENECLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-4900
Mailing Address - Fax:415-369-1367
Practice Address - Street 1:45 CASTRO ST STE 421
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1031
Practice Address - Country:US
Practice Address - Phone:415-600-4900
Practice Address - Fax:412-536-9124
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A22036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine