Provider Demographics
NPI:1134174014
Name:GENSINGER, RAYMOND A JR (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:GENSINGER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 LAVERNA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-9797
Mailing Address - Country:US
Mailing Address - Phone:612-751-8219
Mailing Address - Fax:
Practice Address - Street 1:4938 LAVERNA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62707-9797
Practice Address - Country:US
Practice Address - Phone:612-751-8219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN189222300Medicaid