Individual
FREDERICK ROY RADKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
887 CONGRESS ST, SUITE 400, PORTLAND, ME 04102-3100
(207) 774-6368
(207) 662-7996
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD10664
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113290099
—
ME
05
—
30203950
—
NH
01
—
P00384070
RR MEDICARE
ME
Enumeration date
11/17/2005
Last updated
11/26/2014
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