Individual
MICHAEL DONALD RADOSEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., P.H.D.
Contact information
Practice address
1365 WASHINGTON AVE., SUITE 101, ALBANY, NY 12206-1099
(518) 437-1111
(518) 435-1114
Mailing address
5 MOUNTAIN LEDGE DR, WILTON, NY 12831-2539
(518) 437-1111
(518) 435-1114
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
252133
NY
207W00000X
Ophthalmology Physician
36488
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03092862
—
NY
05
—
0727685
—
IA
01
—
19934
WELLMARK BCBS
IA
Enumeration date
06/27/2006
Last updated
10/01/2015
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