Provider Demographics
NPI:1225006950
Name:RUNYON, MICHAEL BLAKE (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BLAKE
Last Name:RUNYON
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 1:13701 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5040
Mailing Address - Country:US
Mailing Address - Phone:818-997-1216
Mailing Address - Fax:818-997-4458
Practice Address - Street 1:13701 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-5040
Practice Address - Country:US
Practice Address - Phone:818-997-1216
Practice Address - Fax:818-997-4458
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1908213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1908OtherCALIFORNIA STATE LICENSE
AR7369463OtherDEA NUMBER
CAE1908OtherCALIFORNIA STATE LICENSE