Provider Demographics
NPI:1841216751
Name:RADER, ANDREW JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:RADER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3172
Mailing Address - Country:US
Mailing Address - Phone:812-634-2778
Mailing Address - Fax:
Practice Address - Street 1:645 W 5TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3172
Practice Address - Country:US
Practice Address - Phone:812-634-2778
Practice Address - Fax:812-634-2909
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000700213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000306119OtherANTHEM
IN100110820Medicaid
IN000000306119OtherANTHEM