Provider Demographics
NPI:1417441957
Name:ADUSUMILLI, RADHA KISHAN
Entity Type:Individual
Prefix:
First Name:RADHA KISHAN
Middle Name:
Last Name:ADUSUMILLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 SAN PEDRO AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2679
Mailing Address - Country:US
Mailing Address - Phone:210-614-1231
Mailing Address - Fax:210-809-4989
Practice Address - Street 1:3103 MEGAN ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5891
Practice Address - Country:US
Practice Address - Phone:830-773-0212
Practice Address - Fax:830-773-0212
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU1849207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology