Provider Demographics
NPI:1063643187
Name:BRUNNER, DAWN C (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:C
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:WITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3981
Mailing Address - Country:US
Mailing Address - Phone:217-586-6600
Mailing Address - Fax:217-366-5358
Practice Address - Street 1:1001 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-8625
Practice Address - Country:US
Practice Address - Phone:217-586-6600
Practice Address - Fax:217-366-5358
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01090197A207Q00000X
IL036130642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine