Provider Demographics
NPI:1962590687
Name:RADAWSKI, DANIEL PHILIP (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PHILIP
Last Name:RADAWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2591 SOUTH LEATON RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-4950
Mailing Address - Fax:989-775-4680
Practice Address - Street 1:2591 SOUTH LEATON RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-4950
Practice Address - Fax:989-775-4680
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDR035675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5088559Medicaid
AR7502506OtherDEA
A77023Medicare UPIN