Provider Demographics
NPI:1588742563
Name:RADKE, ALAN QUENTON (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:QUENTON
Last Name:RADKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 64979
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164-0979
Mailing Address - Country:US
Mailing Address - Phone:651-431-3684
Mailing Address - Fax:651-431-7505
Practice Address - Street 1:444 LAFAYETTE RD N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55155-3802
Practice Address - Country:US
Practice Address - Phone:651-431-3684
Practice Address - Fax:651-431-7505
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN307562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF26184Medicare UPIN