Individual
CARLOS RAFAEL GONZALEZ RENDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10110 DON S POWERS DR STE 202, MUNSTER, IN 46321-4070
(219) 922-8222
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 392-7084
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01079893A
IN
208600000X
Surgery Physician
036.134436
IL
390200000X
Student in an Organized Health Care Education/Training Program
11014829A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034208
—
IN
Enumeration date
06/01/2009
Last updated
04/30/2020
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