Provider Demographics
NPI:1730921701
Name:RADTKIN, MICHELLE DUNCAN (EX DIRECTOR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DUNCAN
Last Name:RADTKIN
Suffix:
Gender:F
Credentials:EX DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2714
Mailing Address - Country:US
Mailing Address - Phone:419-787-8258
Mailing Address - Fax:
Practice Address - Street 1:2605 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2714
Practice Address - Country:US
Practice Address - Phone:419-787-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X, 374U00000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172A00000XOther Service ProvidersDriver
No374U00000XNursing Service Related ProvidersHome Health Aide