Provider Demographics
NPI:1760943989
Name:RADENTZ, STEPHEN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:RADENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1213
Mailing Address - Country:US
Mailing Address - Phone:317-869-5655
Mailing Address - Fax:317-733-2902
Practice Address - Street 1:295 BEECHWOOD LN
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1213
Practice Address - Country:US
Practice Address - Phone:317-869-5655
Practice Address - Fax:317-733-2902
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056440A207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology