Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 043942 | CT |
N | 111NI0900X | Internist | 043942 | CT |
N | 207R00000X | Internist | MD434754 | PA |
N | 111NI0900X | Internist | MD434754 | PA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 2010014301 | MO |
NPI | 1073582268 |
---|---|
Provider Name | Radhika Mathur |
First Address | Kansas City, MO 64131 |
Second Address | Kansas City, MO 64131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 24/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001439422 | (05) | CT |
I48282 | (02) | CT |