Provider Demographics
NPI:1184675886
Name:RADDEN, LOUIS NATHANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:NATHANIEL
Last Name:RADDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28426 W 8 MILE RD
Mailing Address - Street 2:SUITE 3A 4
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5946
Mailing Address - Country:US
Mailing Address - Phone:248-497-9477
Mailing Address - Fax:
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-792-9496
Practice Address - Fax:248-792-9628
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILR014180207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056315415OtherBCBS OF MI
P00390175OtherMEDICARE RAILROAD
MII47372Medicare UPIN
P42130001Medicare PIN