Healthcare Provider Details

I. General information

NPI: 1477728053
Provider Name (Legal Business Name): HEATHER DAWN RADU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 W CLINCH AVE DEPARTMENT OF EMERGENCY MEDICINE
KNOXVILLE TN
37916-2301
US

IV. Provider business mailing address

1431 CENTERPOINT BLVD SUITE 100
KNOXVILLE TN
37932-1983
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-8101
  • Fax: 865-541-8286
Mailing address:
  • Phone: 865-539-8000
  • Fax: 865-539-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME93150
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD44777
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME93150
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number44777
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: