Healthcare Provider Details

I. General information

NPI: 1376076802
Provider Name (Legal Business Name): RADHIKA KAKARLA MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN STE 405
HOT SPRINGS AR
71913-6441
US

IV. Provider business mailing address

1 MERCY LN STE 405
HOT SPRINGS AR
71913-6441
US

V. Phone/Fax

Practice location:
  • Phone: 501-609-2222
  • Fax: 501-321-9689
Mailing address:
  • Phone: 501-609-2222
  • Fax: 501-321-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-13405
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: