Provider Demographics
NPI:1649234097
Name:RADOVIC, PHILIP ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW
Last Name:RADOVIC
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:665 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2859
Mailing Address - Country:US
Mailing Address - Phone:949-493-8020
Mailing Address - Fax:949-488-0868
Practice Address - Street 1:665 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2859
Practice Address - Country:US
Practice Address - Phone:949-493-8020
Practice Address - Fax:949-488-0868
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3515213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery