Basic Information
| Provider Information | |||||||||
| NPI: | 1841455797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAETZKE | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | DENNIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1654 UPHAM DR | ||||||||
| Address2: | 167 MEANS HALL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142933551 | ||||||||
| FaxNumber: | 6142933124 | ||||||||
| Practice Location | |||||||||
| Address1: | 1654 UPHAM DR | ||||||||
| Address2: | 167 MEANS HALL | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142933551 | ||||||||
| FaxNumber: | 6142933124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35.094950 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.