Provider Demographics
NPI:1043735483
Name:MICHIGAN AVENUE ENT P.C.
Entity Type:Organization
Organization Name:MICHIGAN AVENUE ENT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-229-9000
Mailing Address - Street 1:180 N MICHIGAN AVE STE 1610
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7401
Mailing Address - Country:US
Mailing Address - Phone:312-229-9000
Mailing Address - Fax:312-201-1202
Practice Address - Street 1:180 N MICHIGAN AVE STE 1610
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:312-229-9000
Practice Address - Fax:312-201-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty