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General NPI Number Information
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NPI Number | 1457342610
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Entity Type | Individual
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Provider Name | MICHAEL LOUIS RADZIENDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 19310 S HALSTED ST
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City | GLENWOOD
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State | IL
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Zip | 60425-1562
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Country | US
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Telephone | 708-300-3132
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Fax | 773-790-4034
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Provider Business Mailing Address
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Address Line | 19310 S HALSTED ST
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City | GLENWOOD
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State | IL
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Zip | 60425-1562
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Country | US
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Telephone | 708-300-3132
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Fax | 773-790-4034
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01060676A
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License Number State | IN
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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 | 50075
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036095779
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License Number State | IL
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