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General NPI Number Information
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NPI Number | 1871647859
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Entity Type | Organization
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Legal Business Name | RADIOLOGY NORTHWEST PLLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 160 CASCADE PL SUITE 224
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City | BURLINGTON
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State | WA
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Zip | 98233-3126
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Country | US
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Telephone | 360-933-4524
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Fax |
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Provider Business Mailing Address
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Address Line | 160 CASCADE PL SUITE 224
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City | BURLINGTON
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State | WA
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Zip | 98233-3126
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Country | US
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Telephone | 360-933-4524
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. SERGE D DJUKIC
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Credential | MD
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Telephone | 360-933-4524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | WA
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