Provider Demographics
NPI:1285296343
Name:SHETH, RADHIKA SUKUMAR (MD)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:SUKUMAR
Last Name:SHETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N. EAST AVE.
Mailing Address - Street 2:GME - 2ND FLOOR CAB
Mailing Address - City:JAKCSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:517-205-7147
Mailing Address - Fax:517-205-7050
Practice Address - Street 1:205 N. EAST AVE.
Practice Address - Street 2:GME - 2ND FLOOR CAB
Practice Address - City:JAKCSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-205-7147
Practice Address - Fax:517-205-7050
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301510680207R00000X, 207RI0200X
MI4351045289390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program