Healthcare Provider Details

I. General information

NPI: 1396448189
Provider Name (Legal Business Name): LUKE JAMES RAUDASKOSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LAKEVILLE HWY
PETALUMA CA
94954-5698
US

IV. Provider business mailing address

99 MONTECILLO RD
SAN RAFAEL CA
94903-3308
US

V. Phone/Fax

Practice location:
  • Phone: 707-765-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A25239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: