Provider Demographics
NPI:1932452158
Name:RADICH, JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:RADICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 FERN ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5712
Mailing Address - Country:US
Mailing Address - Phone:845-863-4400
Mailing Address - Fax:
Practice Address - Street 1:2513 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7917
Practice Address - Country:US
Practice Address - Phone:561-331-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008904363A00000X
CAPA59144363A00000X
NC001012360363A00000X
NY016134-1363AM0700X
FL9106969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical