Individual
RADHA S TATINENI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2015 MAXWELL AVE, EVANSVILLE, IN 47711-4359
(812) 422-7974
(812) 422-8163
Mailing address
2015 MAXWELL AVE, EVANSVILLE, IN 47711-4359
(812) 422-7974
(812) 422-8163
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01041148A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378480
ANTHEM PIN
IN
01
—
036070307
IL MEDICAID PIN
IL
05
—
200382560
—
IN
Enumeration date
06/07/2006
Last updated
09/17/2010
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