Provider Demographics
NPI:1528384161
Name:MICHAEL T. RENDLER, PC
Entity Type:Organization
Organization Name:MICHAEL T. RENDLER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:RENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-545-3555
Mailing Address - Street 1:401 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2138
Mailing Address - Country:US
Mailing Address - Phone:719-545-3555
Mailing Address - Fax:719-545-1517
Practice Address - Street 1:401 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2138
Practice Address - Country:US
Practice Address - Phone:719-545-3555
Practice Address - Fax:719-545-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71871853Medicaid