Provider Demographics
NPI:1871758029
Name:JANARDHAN, RADHAKRISHNA (MD)
Entity type:Individual
Prefix:
First Name:RADHAKRISHNA
Middle Name:
Last Name:JANARDHAN
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 1:301 S BEDFORD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3691
Mailing Address - Country:US
Mailing Address - Phone:314-560-7057
Mailing Address - Fax:
Practice Address - Street 1:1421 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2178
Practice Address - Country:US
Practice Address - Phone:608-441-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56746-20208D00000X, 208600000X
MO2008021980390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program