Provider Demographics
NPI:1073582268
Name:MATHUR, RADHIKA (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-363-7710
Mailing Address - Fax:816-363-8414
Practice Address - Street 1:6675 HOLMES RD
Practice Address - Street 2:SUITE 550
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131
Practice Address - Country:US
Practice Address - Phone:816-363-7710
Practice Address - Fax:816-363-8414
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043942207R00000X
MO2010014301207RE0101X
PAMD434754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001439422Medicaid
CTI48282Medicare UPIN
CT110009766Medicare ID - Type Unspecified