Provider Demographics
NPI:1689812570
Name:RADLINSKI, HEIDI (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:RADLINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-514-7550
Mailing Address - Fax:360-514-7587
Practice Address - Street 1:100 EAST 33RD STREET, SUITE 100
Practice Address - Street 2:FAMILY MEDICINE - OBSTETRICS
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-514-7550
Practice Address - Fax:360-514-7587
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106583207Q00000X
RIMD13304207Q00000X
WAMD60549019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001973702OtherMEDICARE PTAN
RIHS82189Medicaid