Provider Demographics
NPI:1821279308
Name:CRAIG M. RUNDBAKEN, D.O. PLLC
Entity Type:Organization
Organization Name:CRAIG M. RUNDBAKEN, D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUNDBAKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-975-0500
Mailing Address - Street 1:13949 W MEEKER BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4436
Mailing Address - Country:US
Mailing Address - Phone:623-975-0500
Mailing Address - Fax:623-975-0705
Practice Address - Street 1:13830 W CAMINO DEL SOL STE 240
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4746
Practice Address - Country:US
Practice Address - Phone:623-975-0500
Practice Address - Fax:623-975-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75430Medicare PIN