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General NPI Number Information
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NPI Number | 1184709594
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Entity Type | Individual
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Provider Name | LOUIS MICHAEL RADNOTHY D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 5210 N 19TH AVE SUITE 121
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City | PHOENIX
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State | AZ
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Zip | 85015-2946
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Country | US
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Telephone | 928-920-0782
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Fax | 928-328-3635
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Provider Business Mailing Address
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Address Line | PO BOX 3147 YUMA PROVING GROUNDS
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City | YUMA
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State | AZ
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Zip | 85365-0903
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Country | US
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Telephone | 928-920-0782
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Fax | 928-328-3635
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4480
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License Number State | AZ
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