Provider Demographics
NPI:1518953025
Name:RADKE, JAMES STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:STEPHEN
Last Name:RADKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 N FEDERAL HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7058
Mailing Address - Country:US
Mailing Address - Phone:954-428-2480
Mailing Address - Fax:954-428-2904
Practice Address - Street 1:5340 N FEDERAL HWY STE 110
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7058
Practice Address - Country:US
Practice Address - Phone:954-428-2480
Practice Address - Fax:954-428-2904
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33833207RG0100X
IL036088439207RG0100X
FLME154298207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32223900Medicaid
WI32223900Medicaid
534450003Medicare ID - Type Unspecified
ILL53773Medicare PIN