# THADDEUS F. RADZIWIECKI, D.P.M., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134163595
- **Authorized official:** DR. THADDEUS F RADZIWIECKI D.P.M. (PRESIDENT/CEO)
- **Authorized official phone:** (219) 838-4000

## Contact information

- **Practice address:** 3641 RIDGE RD, SUITE 6, HIGHLAND, IN 46322-2080
- **Practice address phone:** (219) 838-4000
- **Practice address fax:** (219) 838-4387
- **Mailing address:** 3641 RIDGE RD, SUITE 6, HIGHLAND, IN 46322-2080
- **Mailing address phone:** (219) 838-4000
- **Mailing address fax:** (219) 838-4387

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213E00000X | Podiatrist | 52000081A | IN | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 12/31/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000080130 | BLUE CROSS & BLUE SHIELD | IN |
| 01 | — | 317683484 | CHAMPUS/CHAMPVA | — |
| 01 | — | 480026572 | RAILROAD MEDICARE | — |
| 01 | — | 5622190001 | MEDICARE DMEPOS | IN |