MEDICARE: TAMIKA K ROZEMA 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	208000000X	Pediatrics Physician	R3022	KY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2080P0202X	Pediatric Cardiology Physician	01080769A	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	:	1912265836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMIKA K ROZEMA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1026
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-1026
Country	:	US
Telephone Number	:	317-777-6435
Fax Number	:	317-777-6644

Provider Business Practice Location Address
First Line	:	415 E COOK RD STE 300
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-3657
Country	:	US
Telephone Number	:	317-944-8906
Fax Number	:	317-944-9330

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

Provider Enumeration Date	:	04/28/2012
Last Update Date	:	12/21/2022

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Directions to “ TAMIKA K ROZEMA M.D.” Practice Location

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