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General NPI Number Information
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NPI Number | 1063643187
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Entity Type | Individual
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Provider Name | DAWN C BRUNNER MD
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Gender | Female
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 1001 COMMERCIAL DR
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City | MAHOMET
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State | IL
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Zip | 61853-8625
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Country | US
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Telephone | 217-586-6600
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Fax | 217-366-5358
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Provider Business Mailing Address
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Address Line | 101 W UNIVERSITY AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3981
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Country | US
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Telephone | 217-586-6600
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Fax | 217-366-5358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01090197A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036130642
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License Number State | IL
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