Cooper, Randall Allen

Cooper, Randall Allen is an individual health care provider with primary practice located at 1723 E Bristol St , Elkhart IN 46514-3968. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot Surgery, which is considered as his primary health care specialty. Cooper, Randall Allen can be contacted via phone (574) 264-7180.

Contact Information

Primary practice address
1723 E Bristol St Elkhart IN 46514-3968
Phone: (574) 264-7180
Fax: (574) 264-1875
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 07000384A Indiana

Profile Details

NPI number 1811975667
LBN Legal business name Cooper, Randall Allen
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 3rd, 2006
Last updated Jan 27th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811975667 NPPES
Indiana MEDICAID 100112180
Indiana Other 480010783

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