Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 201100885 | NC |
N | 111NI0900X | Internist | 201100885 | NC |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 2011-00885 | NC |
NPI | 1003026055 |
---|---|
Provider Name | Radhika Pushkar Phadke |
First Address | Fort Lauderdale, FL 33316-2564 |
Second Address | Coconut Creek, FL 33073-4371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 28/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020081500 | (05) | FL |