Healthcare Provider Details

I. General information

NPI: 1114929981
Provider Name (Legal Business Name): TAMARA RENDULIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W LAKE ST WESTLAKE HOSPITAL / ANESTHESIA DEPARTMENT
MELROSE PARK IL
60160-4039
US

IV. Provider business mailing address

3998 FAIR RIDGE DRIVE SUITE 300
FAIRFAX VA
22033-2921
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-3000
  • Fax:
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036107359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: