Provider Demographics
NPI:1043293079
Name:BUKKAPATNAM, RADHIKA NANDUR (MD)
Entity type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:NANDUR
Last Name:BUKKAPATNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8110 LAGUNA BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7904
Mailing Address - Country:US
Mailing Address - Phone:916-683-3950
Mailing Address - Fax:916-683-3970
Practice Address - Street 1:8110 LAGUNA BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7904
Practice Address - Country:US
Practice Address - Phone:916-683-3950
Practice Address - Fax:916-683-3970
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77931207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A779310Medicaid
CAH68525Medicare UPIN
CA00A779310Medicaid