Basic Information
| Provider Information | |||||||||
| NPI: | 1114959525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADUEGE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4348 COUNTY ROAD B | ||||||||
| Address2: | UNIT B | ||||||||
| City: | LAND O LAKES | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545409635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155476118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4348 COUNTY ROAD B | ||||||||
| Address2: | UNIT B | ||||||||
| City: | LAND O LAKES | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545409635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155476118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 12/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 15982 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31144200 | 05 | WI | MEDICAID |