Provider Demographics
NPI:1871647859
Name:RADIOLOGY NORTHWEST PLLC
Entity Type:Organization
Organization Name:RADIOLOGY NORTHWEST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DJUKIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-933-4524
Mailing Address - Street 1:160 CASCADE PL
Mailing Address - Street 2:SUITE 224
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3126
Mailing Address - Country:US
Mailing Address - Phone:360-933-4524
Mailing Address - Fax:
Practice Address - Street 1:160 CASCADE PL
Practice Address - Street 2:SUITE 224
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3126
Practice Address - Country:US
Practice Address - Phone:360-933-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty