Provider Demographics
NPI:1255072542
Name:RUNNE, JOHN WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:RUNNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 DORSET DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8128
Mailing Address - Country:US
Mailing Address - Phone:630-687-3868
Mailing Address - Fax:
Practice Address - Street 1:1875 W DEMPSTER ST STE 470
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1129
Practice Address - Country:US
Practice Address - Phone:847-795-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0796122084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program