Provider Demographics
NPI:1073669297
Name:RADHAKRISHNAN, KADAKKAL R (MD)
Entity Type:Individual
Prefix:
First Name:KADAKKAL
Middle Name:R
Last Name:RADHAKRISHNAN
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 1:9500 EUCLID AVE # R3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-2139
Mailing Address - Country:US
Mailing Address - Phone:216-444-9322
Mailing Address - Fax:216-444-2974
Practice Address - Street 1:9500 EUCLID AVE # R3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-9322
Practice Address - Fax:216-444-2974
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350824162080T0004X, 208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2653525Medicaid
OHRA7373351Medicare PIN