Individual
DR. TERRI J. RADOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
Mailing address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29406
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0141137
MEDICA
—
01
—
1649257213
PREFERRED ONE
MN
01
—
1649257213
WI MEDICAID
WI
01
—
1649257213
UCARE
—
05
—
1649257213
—
MN
05
—
1649257213
—
WI
05
—
597077600
—
MN
Enumeration date
12/27/2005
Last updated
02/05/2013
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