Provider Demographics
NPI:1407812449
Name:RADIN, MICHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:RADIN
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 1:1501 SUPERIOR AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3600
Mailing Address - Country:US
Mailing Address - Phone:949-722-7555
Mailing Address - Fax:949-515-3937
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-722-7555
Practice Address - Fax:949-515-3937
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56739207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060050289OtherRAILROAD MEDICARE
CA00G567390Medicaid
WG56739BMedicare PIN
WG56739AMedicare PIN
B99094Medicare UPIN
060050289OtherRAILROAD MEDICARE