Healthcare Provider Details

I. General information

NPI: 1689769366
Provider Name (Legal Business Name): STEVEN ANDRE RADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE CIR
GENESEO NY
14454-1401
US

IV. Provider business mailing address

16 BRIGHAM CIR
HONEOYE FALLS NY
14472-9248
US

V. Phone/Fax

Practice location:
  • Phone: 585-245-5736
  • Fax: 585-245-5744
Mailing address:
  • Phone: 585-582-1975
  • Fax: 585-245-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number155159-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: