Provider Demographics
NPI:1083619589
Name:RINDERLE, THERESA L (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:RINDERLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9091 ELLERBE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6737
Mailing Address - Country:US
Mailing Address - Phone:318-681-1630
Mailing Address - Fax:318-681-1641
Practice Address - Street 1:9091 ELLERBE RD STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:318-681-1630
Practice Address - Fax:318-681-1641
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.020918207Q00000X
LA20918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1K0589OtherMEDICARE
LAB006OtherTRICARE
LA080049827OtherRR MCR
LA1914533Medicaid
LA2706235006OtherCIGNA
LA4519575OtherAETNA
LA1914533Medicaid
LAB006OtherTRICARE