MEDICARE: DR. ALAN QUENTON RADKE M.D.

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	2084P0800X	Psychiatry Physician	30756	MN

General Provider Information

NPI Number	:	1588742563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN QUENTON RADKE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 64979
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55164-0979
Country	:	US
Telephone Number	:	651-431-3684
Fax Number	:	651-431-7505

Provider Business Practice Location Address
First Line	:	444 LAFAYETTE RD N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55155-3802
Country	:	US
Telephone Number	:	651-431-3684
Fax Number	:	651-431-7505

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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