Healthcare Provider Details

I. General information

NPI: 1518953025
Provider Name (Legal Business Name): JAMES STEPHEN RADKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 N FEDERAL HWY STE 110
LIGHTHOUSE POINT FL
33064-7058
US

IV. Provider business mailing address

5340 N FEDERAL HWY STE 110
LIGHTHOUSE POINT FL
33064-7058
US

V. Phone/Fax

Practice location:
  • Phone: 954-428-2480
  • Fax: 954-428-2904
Mailing address:
  • Phone: 954-428-2480
  • Fax: 954-428-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number33833
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036088439
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME154298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: