Provider Demographics
NPI:1487633640
Name:MENON, RADHIKA (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:MENON
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 1:13733 OFFICE PARK CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7144
Mailing Address - Country:US
Mailing Address - Phone:727-862-2580
Mailing Address - Fax:727-862-9458
Practice Address - Street 1:13733 OFFICE PARK CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7144
Practice Address - Country:US
Practice Address - Phone:727-862-2580
Practice Address - Fax:727-862-9458
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256890000Medicaid
FLME78480OtherSTATE LICENSE
FL256890000Medicaid
FLK3717Medicare ID - Type Unspecified