Basic Information
| Provider Information | |||||||||
| NPI: | 1609831189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATTERMAN | ||||||||
| FirstName: | TRESA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776879 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2051 CLEVIDENCE BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471292278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122806623 | ||||||||
| FaxNumber: | 8126667688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01038674A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 25265 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00000065707 | 01 | KY | ANTHEM / NCMA | OTHER | 009023 | 01 | KY | SIHO / NCMA | OTHER | 100344080 | 05 | IN | MEDICAID | 1194546 | 01 | KY | CHA / NCMA | OTHER | 64252653 | 05 | KY | MEDICAID | 2528638-002 | 01 | KY | CIGNA / NCMA | OTHER | 000023031A | 01 | KY | HUMANA / NCMA | OTHER |