Healthcare Provider Details

I. General information

NPI: 1518990761
Provider Name (Legal Business Name): THOMAS JAMES RENTFROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 S EAST ST SUITE A
INDIANAPOLIS IN
46227-7107
US

IV. Provider business mailing address

205 E SANTA MARIA AVE
EFFINGHAM IL
62401-3025
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-7474
  • Fax:
Mailing address:
  • Phone: 217-347-5736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number01058033A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-080231
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: