Provider Demographics
NPI:1306887161
Name:RADADIYA, SHASHANK B (MD)
Entity type:Individual
Prefix:DR
First Name:SHASHANK
Middle Name:B
Last Name:RADADIYA
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 1:5701 STATE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1281
Mailing Address - Country:US
Mailing Address - Phone:913-287-7800
Mailing Address - Fax:913-596-0072
Practice Address - Street 1:5701 STATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1281
Practice Address - Country:US
Practice Address - Phone:913-287-7800
Practice Address - Fax:913-596-0072
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430009207RR0500X
MO2017013306207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110393OtherBCBS KANSAS
KS100303310AMedicaid
KS24587019OtherBCBS KANSAS CITY
KS110393Medicare ID - Type UnspecifiedKANSAS MEDICARE
KSH79058Medicare UPIN
KSH950000Medicare ID - Type UnspecifiedKANSAS CITY MEDICARE