Provider Demographics
NPI:1073514717
Name:RADTKE, NORMAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:D
Last Name:RADTKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AUDUBON PLAZA DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1319
Mailing Address - Country:US
Mailing Address - Phone:502-636-2823
Mailing Address - Fax:502-634-1646
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-2823
Practice Address - Fax:502-634-1646
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2020-08-26
Deactivation Date:2007-11-05
Deactivation Code:
Reactivation Date:2008-04-01
Provider Licenses
StateLicense IDTaxonomies
KY20988207W00000X
IN01035488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100003470BMedicaid
KY64209885Medicaid
IN100003470DMedicaid
KY000000047621OtherANTHEM
IN100003470AMedicaid
IN412550Medicare PIN
A72384Medicare UPIN
IN100003470DMedicaid
IN212960Medicare PIN
IN635800Medicare PIN
KY1303801Medicare PIN