Provider Demographics
NPI:1700858156
Name:RADLOFF, MONIKA L (MD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:L
Last Name:RADLOFF
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 1:1485 N TURQUOISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-774-7757
Mailing Address - Fax:928-226-3071
Practice Address - Street 1:1485 N TURQUOISE DR
Practice Address - Street 2:STE 200
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1398
Practice Address - Country:US
Practice Address - Phone:928-774-7757
Practice Address - Fax:928-226-3071
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32288207QS0010X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ837073Medicaid
AZ837073Medicaid
AZZ77485Medicare PIN