Provider Demographics
NPI:1952425035
Name:RUNKE, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:RUNKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1605
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7478
Mailing Address - Country:US
Mailing Address - Phone:312-201-1234
Mailing Address - Fax:312-201-1202
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1605
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7478
Practice Address - Country:US
Practice Address - Phone:312-201-1234
Practice Address - Fax:312-201-1202
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-072041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072Medicaid
ILD16018Medicare UPIN