Provider Demographics
NPI:1285627182
Name:RUNYON, LINDA CAREN (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CAREN
Last Name:RUNYON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MI
Mailing Address - Zip Code:48659-9548
Mailing Address - Country:US
Mailing Address - Phone:989-654-3384
Mailing Address - Fax:
Practice Address - Street 1:725 E STATE ST
Practice Address - Street 2:STERLING AREA HEALTH CENTER
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9548
Practice Address - Country:US
Practice Address - Phone:989-654-2491
Practice Address - Fax:989-654-2190
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048990207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIME5025073831802OtherME#
MIM83480004Medicare PIN
MIB44681Medicare UPIN