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General NPI Number Information
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NPI Number | 1316103286
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Entity Type | Organization
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Legal Business Name | PAULINA MED CLINIC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 3525 W PETERSON AVE SUITE 611
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City | CHICAGO
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State | IL
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Zip | 60659-3324
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Country | US
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Telephone | 773-583-7793
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Fax | 773-583-7796
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Provider Business Mailing Address
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Address Line | 3525 W PETERSON AVE SUITE 611
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City | CHICAGO
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State | IL
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Zip | 60659-3324
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Country | US
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Telephone | 773-583-7793
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Fax | 773-583-7796
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ANDREA RENTEA
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Credential | M.D.
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Telephone | 773-583-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036058737
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License Number State | IL
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