Individual
JAMES HENRY RADACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2420 LAKE AVE, ASHTABULA, OH 44004-4954
(440) 997-2262
Mailing address
1719 ALVIN AVE, CLEVELAND, OH 44109-4609
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35048880
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0651861
—
OH
01
—
942460636912
CARESOURCE
OH
01
—
P00194548
MEDICARE TRAVELERS RR-GA
OH
Enumeration date
06/07/2006
Last updated
07/08/2007
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