Organization
THADDEUS F. RADZIWIECKI, D.P.M., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THADDEUS F RADZIWIECKI D.P.M. (PRESIDENT/CEO)
(219) 838-4000
Entity
Organization
Contact information
Practice address
3641 RIDGE RD, SUITE 6, HIGHLAND, IN 46322-2080
(219) 838-4000
(219) 838-4387
Mailing address
3641 RIDGE RD, SUITE 6, HIGHLAND, IN 46322-2080
(219) 838-4000
(219) 838-4387
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
52000081A
IN
Other
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
Enumeration date
06/16/2006
Last updated
12/31/2009
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