MEDICARE: CARLOS RAFAEL GONZALEZ RENDON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036.134436	IL
2	390200000X	Student in an Organized Health Care Education/Training Program	11014829A	IN
3	208600000X	Surgery Physician	01079893A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467688879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS RAFAEL GONZALEZ RENDON M.D.

Provider Business Mailing Address
First Line	:	8558 BROADWAY
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-7032
Country	:	US
Telephone Number	:	219-392-7084
Fax Number	:	219-703-6854

Provider Business Practice Location Address
First Line	:	10110 DON S POWERS DR STE 202
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4070
Country	:	US
Telephone Number	:	219-922-8222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	04/30/2020

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Directions to “ CARLOS RAFAEL GONZALEZ RENDON M.D.” Practice Location

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