Individual
DR. DOUGLAS JOHN RAEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
3850 GLENKERRY CT, PORTAGE, MI 49024-0700
(269) 327-7200
(269) 327-9272
Mailing address
3850 GLENKERRY CT, PORTAGE, MI 49024-0700
(269) 327-7200
(269) 327-9272
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
DR009649
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1753900045
BLUE CROSS BLUE SHIELDI
MI
05
—
2745903
—
MI
Enumeration date
12/19/2007
Last updated
05/10/2011
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