MEDICARE: DR. NICHOLAS RUNGE DO

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	207X00000X	Orthopaedic Surgery Physician	5101028806	MI
2	207X00000X	Orthopaedic Surgery Physician	OS23208	FL

General Provider Information

NPI Number	:	1093389967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS RUNGE DO

Provider Business Mailing Address
First Line	:	28050 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-5919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28050 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-5919
Country	:	US
Telephone Number	:	947-521-8000
Fax Number	:

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

Provider Enumeration Date	:	05/16/2021
Last Update Date	:	03/03/2026

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Directions to “ DR. NICHOLAS RUNGE DO” Practice Location

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