Provider Demographics
NPI:1730132655
Name:TWARDOWSKI, RADOMYSL M (MD)
Entity Type:Individual
Prefix:DR
First Name:RADOMYSL
Middle Name:M
Last Name:TWARDOWSKI
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 1:2937 CARRIAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0113
Mailing Address - Country:US
Mailing Address - Phone:701-258-7901
Mailing Address - Fax:701-250-7133
Practice Address - Street 1:2937 CARRIAGE CIR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0113
Practice Address - Country:US
Practice Address - Phone:701-258-7901
Practice Address - Fax:701-250-7133
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6950207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18001Medicaid
ND18001Medicaid