Healthcare Provider Details

I. General information

NPI: 1730921701
Provider Name (Legal Business Name): MICHELLE DUNCAN RADTKIN EX. DIRECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 EVERGREEN RD
TOLEDO OH
43606-2714
US

IV. Provider business mailing address

2605 EVERGREEN RD
TOLEDO OH
43606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 419-787-8258
  • Fax:
Mailing address:
  • Phone: 419-787-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: