Healthcare Provider Details

I. General information

NPI: 1235326455
Provider Name (Legal Business Name): THOMAS A RUNNE DPM LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 S BELL SCHOOL RD STE 2
ROCKFORD IL
61108-1405
US

IV. Provider business mailing address

1955 W DOWNER PL
AURORA IL
60506-4384
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004049
License Number StateIL

VIII. Authorized Official

Name: TINA BOMBARD
Title or Position: BILLING DIRECTOR
Credential:
Phone: 630-897-6851