Provider Demographics
NPI:1245643808
Name:RADHAKRISHNAN, SHREE LATA (MD)
Entity type:Individual
Prefix:
First Name:SHREE LATA
Middle Name:
Last Name:RADHAKRISHNAN
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 1:7450 S MASON MONTGOMERY RD UNIT 200
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8080
Mailing Address - Country:US
Mailing Address - Phone:513-585-2410
Mailing Address - Fax:
Practice Address - Street 1:7450 S MASON MONTGOMERY RD UNIT 200
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8080
Practice Address - Country:US
Practice Address - Phone:513-585-2410
Practice Address - Fax:513-792-7807
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016519207R00000X
MA270227207R00000X
OH35.142755207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine