Basic Information
| Provider Information | |||||||||
| NPI: | 1487725917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUESSNER | ||||||||
| FirstName: | RAINER | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 SALINA MEADOWS PKWY | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154642096 | ||||||||
| FaxNumber: | 3154642010 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 EAST ADAMS ST | ||||||||
| Address2: | STE 2W | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154649535 | ||||||||
| FaxNumber: | 3154646288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 36718 | AZ | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 33689 | MN | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | 280878 | NY | Y | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 280878 | NY | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1712215 | 01 | MEDICA - CHOICE | OTHER | 2T096GR | 01 | BLUE CROSS BLUE SHIELD | OTHER | HP22171 | 01 | HEALTHPARTNERS | OTHER | 0977264 | 05 | IA | MEDICAID | 101022 | 01 | UCARE | OTHER | P00435421 | 01 | AZ | RAILROAD MEDICARE | OTHER | 1712215 | 01 | MEDICA - PRIMARY | OTHER | 213545 | 05 | AZ | MEDICAID | 690580300 | 05 | MN | MEDICAID | 0060697 | 05 | MT | MEDICAID | 1009125 | 01 | PREFERREDONE | OTHER | 763592 | 01 | ARAZ | OTHER |