Provider Demographics
NPI:1154355667
Name:RUNDE, SCOTT E (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:RUNDE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-2172
Mailing Address - Country:US
Mailing Address - Phone:763-389-6353
Mailing Address - Fax:763-389-7688
Practice Address - Street 1:919 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-2172
Practice Address - Country:US
Practice Address - Phone:763-389-6353
Practice Address - Fax:763-389-7688
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN733213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8376790Medicaid
WA182431OtherLABOR & INDUSTRIES
WAU85609Medicare UPIN
WA182431OtherLABOR & INDUSTRIES