Provider Demographics
NPI:1679541395
Name:RUHNKE, GREGORY WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:RUHNKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5841 SOUTH MARYLAND AVENUE
Mailing Address - Street 2:UNIVERSITY OF CHICAGO MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2007
Mailing Address - Country:US
Mailing Address - Phone:773-702-5212
Mailing Address - Fax:773-702-1295
Practice Address - Street 1:15 PARKMAN STREET WAC 108
Practice Address - Street 2:MEDICAL WALK IN UNIT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0143235Medicaid
MA210964OtherTUFTS HEALTH PLAN
MAJ23727OtherBCBS MA
MAJ23727OtherBCBS MA
H48690Medicare UPIN