Radtke, Wallace E
Radtke, Wallace E is an individual health care provider with primary practice located at 801 Broadway N , Fargo ND 58102-3641. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Radtke, Wallace E can be contacted via phone (701) 234-2371.Contact Information
Primary practice address
801 Broadway N
Fargo ND 58102-3641
Phone: (701) 234-2371
Fax: (701) 234-3813
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 3798 | North Dakota |
Profile Details
| NPI number | 1134140353 |
|---|---|
| LBN Legal business name | Radtke, Wallace E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 22nd, 2006 |
| Last updated | May 2nd, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134140353 | NPPES |
| Minnesota | MEDICAID | 258285600 | |
| Minnesota | MEDICAID | 12479 |
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