Provider Demographics
NPI:1760442214
Name:RUNDE, CHARLES W (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:RUNDE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1207 NETWORK CENTRE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4632
Mailing Address - Country:US
Mailing Address - Phone:217-347-2707
Mailing Address - Fax:217-347-2827
Practice Address - Street 1:206 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-1134
Practice Address - Country:US
Practice Address - Phone:217-857-6481
Practice Address - Fax:217-857-6094
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036063908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0022540104OtherBLUE CROSS BLUE SHIELD IL
IL002589OtherHEALTH ALLIANCE
IL561920OtherMEDICARE GROUP
IL080152119OtherRAILROAD MEDICARE
IL246811OtherHEALTHLINK
IL170985OtherPERSONAL CARE
IL036063908OtherILLINOIS LICENSE
IL371391171004Medicaid
873641OtherFIRST HEALTH/ COVENTRY
IL336028350OtherILLINOIS CONTROLLED SUBSTANCE LICENSE
AR2233574OtherDEA #
IL148962Medicare Oscar/Certification
IL080152119OtherRAILROAD MEDICARE
873641OtherFIRST HEALTH/ COVENTRY