Provider Demographics
NPI:1184745929
Name:RADOSTITZ, JULIE CAROL (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CAROL
Last Name:RADOSTITZ
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 1:8875 SW ROSEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1370
Mailing Address - Country:US
Mailing Address - Phone:503-297-6051
Mailing Address - Fax:
Practice Address - Street 1:0615 SW PALATINE HILL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7879
Practice Address - Country:US
Practice Address - Phone:503-768-7165
Practice Address - Fax:503-768-7167
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG22729Medicare UPIN