Provider Demographics
NPI:1518993872
Name:RUNYAN, DAVID LLOYD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LLOYD
Last Name:RUNYAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1936
Mailing Address - Country:US
Mailing Address - Phone:906-632-3001
Mailing Address - Fax:906-632-3015
Practice Address - Street 1:545 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1936
Practice Address - Country:US
Practice Address - Phone:906-632-3001
Practice Address - Fax:906-632-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR67278Medicare UPIN
MI0P30050Medicare PIN