Provider Demographics
NPI:1205009396
Name:RADECKI, PATRICK LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LOUIS
Last Name:RADECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3033
Mailing Address - Country:US
Mailing Address - Phone:503-222-3636
Mailing Address - Fax:503-223-5139
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:SUITE 607
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-222-3636
Practice Address - Fax:503-223-5139
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13579174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR291880Medicaid
OR0000BHSMHMedicare PIN