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General NPI Number Information
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NPI Number | 1760442214
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Entity Type | Individual
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Provider Name | CHARLES W. RUNDE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 206 N PEARL ST
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City | TEUTOPOLIS
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State | IL
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Zip | 62467-1134
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Country | US
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Telephone | 217-857-6481
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Fax | 217-857-6094
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Provider Business Mailing Address
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Address Line | 1207 NETWORK CENTRE DR SUITE 3
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City | EFFINGHAM
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State | IL
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Zip | 62401-4632
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Country | US
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Telephone | 217-347-2707
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Fax | 217-347-2827
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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 | 036063908
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License Number State | IL
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