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General NPI Number Information
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NPI Number | 1609831189
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Entity Type | Individual
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Provider Name | TRESA V RATTERMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 2051 CLEVIDENCE BLVD STE C
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City | CLARKSVILLE
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State | IN
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Zip | 47129-2278
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Country | US
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Telephone | 812-280-6623
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Fax | 812-666-7688
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25265
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01038674A
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License Number State | IN
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