Provider Demographics
NPI:1275614356
Name:RADMER, CHARLES R (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:RADMER
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 1:1704 COMMERCIAL CIR
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-9690
Mailing Address - Country:US
Mailing Address - Phone:785-456-2207
Mailing Address - Fax:785-456-7932
Practice Address - Street 1:1704 COMMERCIAL CIR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-9690
Practice Address - Country:US
Practice Address - Phone:785-456-2207
Practice Address - Fax:785-456-7932
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100183207Q00000X
KS0532864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200537040AMedicaid
KS106930Medicare PIN