Provider Demographics
NPI:1407211428
Name:SOKHAL, RADHIKA (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:SOKHAL
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 ALLEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1963
Mailing Address - Country:US
Mailing Address - Phone:313-382-0505
Mailing Address - Fax:313-382-1584
Practice Address - Street 1:7445 ALLEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1963
Practice Address - Country:US
Practice Address - Phone:313-382-0505
Practice Address - Fax:313-382-1584
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249062363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology