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NPI Code Detail

MEDICARE: DR. SHANNON B RADKE M.D.

MEDICARE: DR. SHANNON B RADKE M.D.
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
1207Q00000XFamily Medicine PhysicianMD00036530WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992897276
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON B RADKE M.D.
Provider Business Mailing Address
First Line : 714 W PINE ST
Second Line :
City : NEWPORT
State : WA
Zip : 99156-9046
Country : US
Telephone Number : 509-447-2441
Fax Number : 509-447-0456
Provider Business Practice Location Address
First Line : 714 W PINE ST
Second Line :
City : NEWPORT
State : WA
Zip : 99156-9046
Country : US
Telephone Number : 509-447-2441
Fax Number : 509-447-0456
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 03/18/2025

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Directions to “ DR. SHANNON B RADKE M.D.” Practice Location

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