MEDICARE: ALEXANDER RUNOWSKI 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	207Q00000X	Family Medicine Physician	4301058995	MI
2	183500000X	Pharmacist	5302410956	MI

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
2	1104840529	OTHER	MI	BCBSM - BRONSON URGENT CARE

General Provider Information

NPI Number	:	1154439339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER RUNOWSKI M.D.

Provider Business Mailing Address
First Line	:	601 JOHN ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5341
Country	:	US
Telephone Number	:	269-341-7806
Fax Number	:	269-341-8743

Provider Business Practice Location Address
First Line	:	680 W COLUMBIA AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-3028
Country	:	US
Telephone Number	:	269-965-4500
Fax Number	:	269-965-1150

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	05/10/2011

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