Basic Information
| Provider Information | |||||||||
| NPI: | 1154439339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUNOWSKI | ||||||||
| FirstName: | ALEXANDER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 JOHN ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693417806 | ||||||||
| FaxNumber: | 2693418743 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 W COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490153028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699654500 | ||||||||
| FaxNumber: | 2699651150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301058995 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 183500000X | 5302410956 | MI | N | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 1154439339 | 05 | MI | MEDICAID | 1104840529 | 01 | MI | BCBSM - BRONSON URGENT CARE | OTHER |