Provider Demographics
NPI:1194838037
Name:RADHAKRISHNAN, ABHILASHA (MD)
Entity Type:Individual
Prefix:
First Name:ABHILASHA
Middle Name:
Last Name:RADHAKRISHNAN
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:OF INTERNAL MEDICINE
Mailing Address - Street 2:530 NE GLEN OAK AVENUE
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-655-3292
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF INTERNAL MEDICINE
Practice Address - Street 2:530 NE GLEN OAK AVENUE
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine