MEDICARE: JAMES STEPHEN RADKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	33833	WI
2	207RG0100X	Gastroenterology Physician	036088439	IL
3	207RG0100X	Gastroenterology Physician	ME154298	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518953025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES STEPHEN RADKE MD

Provider Business Mailing Address
First Line	:	5340 N FEDERAL HWY STE 110
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-428-2480
Fax Number	:	954-428-2904

Provider Business Practice Location Address
First Line	:	5340 N FEDERAL HWY STE 110
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7058
Country	:	US
Telephone Number	:	954-428-2480
Fax Number	:	954-428-2904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	02/14/2025

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Directions to “ JAMES STEPHEN RADKE MD” Practice Location

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