Provider Demographics
NPI:1609831189
Name:RATTERMAN, TRESA V (MD)
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:V
Last Name:RATTERMAN
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:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2051 CLEVIDENCE BLVD STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2278
Practice Address - Country:US
Practice Address - Phone:812-280-6623
Practice Address - Fax:812-666-7688
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25265208000000X
IN01038674A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1194546OtherCHA / NCMA
KY2528638-002OtherCIGNA / NCMA
IN100344080Medicaid
KY64252653Medicaid
KY00000065707OtherANTHEM / NCMA
KY009023OtherSIHO / NCMA
KY000023031AOtherHUMANA / NCMA
KY64252653Medicaid
IN100344080Medicaid
IN196290SSSMedicare PIN