Provider Demographics
NPI:1952926685
Name:RUNGE, MASON
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:RUNGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E. MEDICAL CENTER DR
Mailing Address - Street 2:TC 1910 / SPC 5314
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109
Mailing Address - Country:US
Mailing Address - Phone:734-936-4054
Mailing Address - Fax:734-647-2540
Practice Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Practice Address - Street 2:TC1910 / SPC5314
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:734-936-4054
Practice Address - Fax:734-647-2540
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program