Provider Demographics
NPI:1932528676
Name:RUNYAN, ALIYE (MD)
Entity Type:Individual
Prefix:
First Name:ALIYE
Middle Name:
Last Name:RUNYAN
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 1:1623 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3235
Mailing Address - Country:US
Mailing Address - Phone:727-504-9423
Mailing Address - Fax:
Practice Address - Street 1:30 NORTH 1900 EAST 2A200
Practice Address - Street 2:DEPT OF OBGYN
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132
Practice Address - Country:US
Practice Address - Phone:313-993-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
390200000X
UT10649987-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program