Healthcare Provider Details

I. General information

NPI: 1326088741
Provider Name (Legal Business Name): RADHA S TATINENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MAXWELL AVE
EVANSVILLE IN
47711-4359
US

IV. Provider business mailing address

2015 MAXWELL AVE
EVANSVILLE IN
47711-4359
US

V. Phone/Fax

Practice location:
  • Phone: 812-422-7974
  • Fax: 812-422-8163
Mailing address:
  • Phone: 812-422-7974
  • Fax: 812-422-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01041148A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: