Provider Demographics
NPI:1164599809
Name:RENTEA, ANDREA E (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:E
Last Name:RENTEA
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 1:3525 WEST PETERSON
Mailing Address - Street 2:SUITE 611
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-583-7793
Mailing Address - Fax:773-583-7796
Practice Address - Street 1:3525 WEST PETERSON
Practice Address - Street 2:SUITE 611
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659
Practice Address - Country:US
Practice Address - Phone:773-583-7793
Practice Address - Fax:773-583-7796
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058737208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24060Medicare UPIN
IL733580Medicare ID - Type Unspecified