Provider Demographics
NPI:1508883315
Name:RADAWSKI, BARBARA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:RADAWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:LYNN
Other - Last Name:WINKELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3909 TIMBERWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-5004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3909 TIMBERWOOD DR SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-5004
Practice Address - Country:US
Practice Address - Phone:616-214-7237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003007363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM08620059Medicare PIN
MIP36090Medicare UPIN
MI0M74460662Medicare PIN