Provider Demographics
NPI:1730271479
Name:RADTKE, RODNEY ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ALLAN
Last Name:RADTKE
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 1:3201 WILD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1952
Mailing Address - Country:US
Mailing Address - Phone:919-383-2497
Mailing Address - Fax:
Practice Address - Street 1:TRENT DR
Practice Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-3448
Practice Address - Fax:919-684-8955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC280792084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8969924Medicaid
NC8969924Medicaid
NC2097800Medicare ID - Type Unspecified