Provider Demographics
NPI:1992813810
Name:NORMAN D. RADTKE, MD, PSC
Entity type:Organization
Organization Name:NORMAN D. RADTKE, MD, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RADTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-636-2823
Mailing Address - Street 1:3 AUDUBON PLAZA DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1319
Mailing Address - Country:US
Mailing Address - Phone:502-636-2823
Mailing Address - Fax:502-634-1646
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-2823
Practice Address - Fax:502-634-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-26
Deactivation Date:2008-09-18
Deactivation Code:
Reactivation Date:2008-11-07
Provider Licenses
StateLicense IDTaxonomies
KY20988207W00000X
IN01035488A207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100003470AMedicaid
KY64209885Medicaid
IN100003470FMedicaid
IN100003470BMedicaid
IN100003470DMedicaid
IN212960Medicare PIN
KY1303801Medicare PIN
A72384Medicare UPIN
KY01244Medicare PIN
KY64209885Medicaid
IN412550Medicare PIN