Provider Demographics
NPI:1023156080
Name:RUNGE, CHRISTINA L (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:L
Last Name:RUNGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:RUNGE SAMUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:OTOLARYNGOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5562
Mailing Address - Fax:414-805-7936
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:OTOLARYNGOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5562
Practice Address - Fax:414-805-7936
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI405231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1023156080Medicaid
WI680861012Medicare PIN
WI736012243Medicare PIN