Provider Demographics
NPI:1194107102
Name:ANNAM, RADHIKA
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:ANNAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N. MAPLE ST.
Mailing Address - Street 2:JOSLIN DIABETES CENTER AFFILIATE AT HSHS MEDICAL GROUP
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401
Mailing Address - Country:US
Mailing Address - Phone:217-787-8870
Mailing Address - Fax:217-347-6698
Practice Address - Street 1:500 N. MAPLE ST.
Practice Address - Street 2:JOSLIN DIABETES CENTER AFFILIATE AT HSHS MEDICAL GROUP
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-787-8870
Practice Address - Fax:217-347-6698
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036151160207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program