Individual
CALLIE JO RADOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT, MSES
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-2056
Mailing address
320 QUAIL CIR, WEST BEND, WI 53095-7815
(414) 801-6431
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1496-39
WI
Other
Enumeration date
02/17/2015
Last updated
12/28/2018
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