Basic Information
| Provider Information | |||||||||
| NPI: | 1902331986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUNNER | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | MCDOUGAL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCDOUGAL | ||||||||
| OtherFirstName: | MARGARET | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 49 JESSE HILL JR DR SE # 480A | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042518796 | ||||||||
| FaxNumber: | 4042518680 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 W 13 MILE RD STE LL-20 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482882280 | ||||||||
| FaxNumber: | 2483190170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | 4301504322 | MI | Y | 207W00000X | 4301504322 | MI | N | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.