Healthcare Provider Details

I. General information

NPI: 1497731293
Provider Name (Legal Business Name): THOMAS A RUNNE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
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: 815-260-7731
  • Fax: 630-897-6851
Mailing address:
  • Phone: 815-260-7731
  • Fax: 630-897-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: