Healthcare Provider Details

I. General information

NPI: 1124604962
Provider Name (Legal Business Name): NATHAN ANDREW RADAKOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE # S380
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

3511 LARRABEE AVE
BELLINGHAM WA
98229-3231
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9363
  • Fax:
Mailing address:
  • Phone: 509-432-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA195539
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA195539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: