Provider Demographics
NPI:1003026055
Name:PHADKE, RADHIKA PUSHKAR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:PUSHKAR
Last Name:PHADKE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SE 3RD AVE
Mailing Address - Street 2:THIRD FLOOR PBO
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-481-9184
Mailing Address - Fax:
Practice Address - Street 1:4800 W HILLSBORO BLVD
Practice Address - Street 2:SUITE A-6
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4371
Practice Address - Country:US
Practice Address - Phone:954-481-9184
Practice Address - Fax:954-481-9317
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201100885207R00000X
NC2011-00885207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020081500Medicaid