Provider Demographics
NPI:1326538273
Name:JAIN, RADHIKA (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 HOLLY HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2410
Mailing Address - Country:US
Mailing Address - Phone:314-353-5190
Mailing Address - Fax:314-353-1310
Practice Address - Street 1:4352 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2138
Practice Address - Country:US
Practice Address - Phone:314-531-5444
Practice Address - Fax:314-531-0063
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA287484207R00000X
MO20223035801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine