Provider Demographics
NPI:1144254103
Name:RADKOWSKY, ALLEN K (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:K
Last Name:RADKOWSKY
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 1:4494 W PEORIA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2025
Mailing Address - Country:US
Mailing Address - Phone:623-847-4722
Mailing Address - Fax:623-847-4818
Practice Address - Street 1:4494 W PEORIA AVE STE 116
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2025
Practice Address - Country:US
Practice Address - Phone:623-847-4722
Practice Address - Fax:623-847-4818
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21335Medicare ID - Type UnspecifiedMEDICARE CERTIFICATE NUMB