Healthcare Provider Details

I. General information

NPI: 1871758029
Provider Name (Legal Business Name): RADHAKRISHNA JANARDHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 S PARK ST
MADISON WI
53715-2178
US

IV. Provider business mailing address

301 S BEDFORD ST STE 1
MADISON WI
53703-3691
US

V. Phone/Fax

Practice location:
  • Phone: 608-441-6888
  • Fax:
Mailing address:
  • Phone: 314-560-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2008021980
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56746-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number56746-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: