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General NPI Number Information
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NPI Number | 1114945144
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Entity Type | Individual
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Provider Name | RADHIKA KOSARAJU MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 1404 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61104-2335
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Country | US
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Telephone | 815-967-5476
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 MINERAL POINT AVE
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City | JANESVILLE
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State | WI
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Zip | 53548-2940
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Country | US
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Telephone | 608-756-6000
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Fax | 608-756-6236
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 53725-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5301083282
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 53725-020
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036118570
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License Number State | IL
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