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General NPI Number Information
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NPI Number | 1487618179
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Entity Type | Individual
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Provider Name | MICHAEL R RADER MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 PFIZER DR
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City | TERRE HAUTE
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State | IN
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Zip | 47802-8019
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Country | US
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Telephone | 812-299-2121
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Fax | 812-299-6123
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Provider Business Mailing Address
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Address Line | 585 WOODBINE
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City | TERRE HAUTE
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State | IN
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Zip | 47803-1759
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Country | US
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Telephone | 812-239-2947
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Fax | 812-299-6123
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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 | 1026731A
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License Number State | IN
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