Individual
DR. THADDEUS F RADZIWIECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
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
07000594A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000080130
ANTHEM BLUE CROSS SHIELD
IN
01
—
480026572
RAILROAD MEDICARE
—
01
—
5622190001
MEDICARE DMEPOS
IN
Enumeration date
06/26/2006
Last updated
12/31/2009
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