Provider Demographics
NPI:1720072903
Name:RUNDBAKEN, CRAIG MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MICHAEL
Last Name:RUNDBAKEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13949 W MEEKER BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4436
Mailing Address - Country:US
Mailing Address - Phone:623-975-0500
Mailing Address - Fax:623-975-0705
Practice Address - Street 1:13830 W CAMINO DEL SOL STE 240
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4746
Practice Address - Country:US
Practice Address - Phone:623-975-0500
Practice Address - Fax:623-975-0705
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3219207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391409Medicaid
AZ391409Medicaid
Z75431Medicare PIN