MEDICARE: JOSEPH RADICH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085.008904	IL
2	363A00000X	Physician Assistant	PA59144	CA
3	363A00000X	Physician Assistant	001012360	NC
4	363AM0700X	Medical Physician Assistant	016134-1	NY
5	363A00000X	Physician Assistant	9106969	FL

General Provider Information

NPI Number	:	1932452158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH RADICH PA-C

Provider Business Mailing Address
First Line	:	636 FERN ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5712
Country	:	US
Telephone Number	:	845-863-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2513 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-7917
Country	:	US
Telephone Number	:	561-331-2983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	12/20/2022

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