Basic Information
| Provider Information | |||||||||
| NPI: | 1760442214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUNDE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1207 NETWORK CENTRE DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624014632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173472707 | ||||||||
| FaxNumber: | 2173472827 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 N PEARL ST | ||||||||
| Address2: | |||||||||
| City: | TEUTOPOLIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624671134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178576481 | ||||||||
| FaxNumber: | 2178576094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 05/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036063908 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0022540104 | 01 | IL | BLUE CROSS BLUE SHIELD IL | OTHER | 002589 | 01 | IL | HEALTH ALLIANCE | OTHER | 561920 | 01 | IL | MEDICARE GROUP | OTHER | 080152119 | 01 | IL | RAILROAD MEDICARE | OTHER | 246811 | 01 | IL | HEALTHLINK | OTHER | 170985 | 01 | IL | PERSONAL CARE | OTHER | 036063908 | 01 | IL | ILLINOIS LICENSE | OTHER | 371391171004 | 05 | IL | MEDICAID | 873641 | 01 | FIRST HEALTH/ COVENTRY | OTHER | 336028350 | 01 | IL | ILLINOIS CONTROLLED SUBSTANCE LICENSE | OTHER | AR2233574 | 01 | DEA # | OTHER |