Provider Demographics
NPI:1902006687
Name:RADKE, JASON (MMS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:RADKE
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 BARRINGTON RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1090
Mailing Address - Country:US
Mailing Address - Phone:847-839-7522
Mailing Address - Fax:847-885-4568
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:SUITE 505
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1090
Practice Address - Country:US
Practice Address - Phone:847-839-7522
Practice Address - Fax:847-885-4568
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002844363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical