Provider Demographics
NPI:1972835502
Name:JEFFREY M RADACK DPM PLLC
Entity Type:Organization
Organization Name:JEFFREY M RADACK DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RADACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:469-742-0406
Mailing Address - Street 1:8951 COLLIN MCKINNEY PKWY STE 603
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1007
Mailing Address - Country:US
Mailing Address - Phone:469-742-0406
Mailing Address - Fax:469-952-2806
Practice Address - Street 1:8951 COLLIN MCKINNEY PKWY STE 603
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1007
Practice Address - Country:US
Practice Address - Phone:469-742-0406
Practice Address - Fax:469-952-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-07
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1617261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6656030001OtherDME PTAN
TXU92764Medicare UPIN