Provider Demographics
NPI:1881691210
Name:RUNOWICZ, CAROLYN D (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:D
Last Name:RUNOWICZ
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 1:11200 S.W. 8TH ST.
Mailing Address - Street 2:HLS 11-693
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33199
Mailing Address - Country:US
Mailing Address - Phone:305-348-0570
Mailing Address - Fax:305-348-0123
Practice Address - Street 1:885 SW 109 AVE
Practice Address - Street 2:ROOM 130
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:305-348-3627
Practice Address - Fax:305-348-4261
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041792207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1417923Medicaid
CT1417923Medicaid
CTA96052Medicare UPIN