Provider Demographics
NPI:1437261120
Name:RADOSEVICH, DANIEL GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GEORGE
Last Name:RADOSEVICH
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 1:1000 E UNIVERSITY AVE
Mailing Address - Street 2:DEPARTMENT 3068
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82071
Mailing Address - Country:US
Mailing Address - Phone:307-766-2130
Mailing Address - Fax:307-766-2711
Practice Address - Street 1:1000 E UNIVERSITY AVE
Practice Address - Street 2:DEPARTMENT 3068
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071
Practice Address - Country:US
Practice Address - Phone:307-766-2130
Practice Address - Fax:307-766-2711
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5240A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine