MEDICARE: DR. CYNTHIA MARIE RUNNING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	48791	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023171766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA MARIE RUNNING M.D.

Provider Business Mailing Address
First Line	:	10532 N PORT WASHINGTON RD
Second Line	:	SUITE 1A
City	:	MEQUON
State	:	WI
Zip	:	53092-5563
Country	:	US
Telephone Number	:	262-240-9744
Fax Number	:	262-240-9745

Provider Business Practice Location Address
First Line	:	10532 N PORT WASHINGTON RD
Second Line	:	SUITE 1A
City	:	MEQUON
State	:	WI
Zip	:	53092-5563
Country	:	US
Telephone Number	:	262-240-9744
Fax Number	:	262-240-9745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	07/07/2011

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