Midway Medical Clinic Steven P. Radjenovich D.O. LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22233 Issued in MN

Legal business name

MIDWAY MEDICAL CLINIC STEVEN P. RADJENOVICH D.O. LLC

Practice address

119 30TH Ave W
Alexandria, MN 56308-3433

Phone

(320) 763-6452

Fax

(320) 763-2971

NPI assigned

Sep 27, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Steven Perl Radjenovich, D.O.

Title

President

Phone

(320) 763-6452

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359590400000",
    "number": "1184610974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 30TH AVE W",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083433",
            "telephone_number": "320-763-6452",
            "fax_number": "320-763-2971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 30TH AVE W",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083433",
            "telephone_number": "320-763-6452",
            "fax_number": "320-763-2971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY MEDICAL CLINIC STEVEN P. RADJENOVICH D.O. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2013-01-31",
        "status": "A",
        "authorized_official_last_name": "RADJENOVICH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "PERL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-763-6452",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "22233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "449883600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph1940 Harry Merickel, M.D.
• Mary Kay Metz, LADC
• Carla Meyer, PHARMD
• Michael H. Collins, DDS, PA
• Zachary Benson Middleton, PTA
• Midwest Vision Centers Inc (Midwest Vision Centers)
• Kelley Mikkelson
• Roxanne Luella Mikkelson, LPN
• Angela Lynn Miller, ATC
• Emily Marie Miller

• Family Medicine Physician in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.