MEDICARE: DR. NANCY S RUNG DPM

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	213E00000X	Podiatrist	36 00 1826 R	OH

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	:	1568448298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY S RUNG DPM

Provider Business Mailing Address
First Line	:	219 WASHINGTON ST
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2640
Country	:	US
Telephone Number	:	440-593-3444
Fax Number	:	440-593-6183

Provider Business Practice Location Address
First Line	:	219 WASHINGTON ST
Second Line	:
City	:	CONNEAUT
State	:	OH
Zip	:	44030-2640
Country	:	US
Telephone Number	:	440-593-3444
Fax Number	:	440-593-6183

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	06/09/2008

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