Randall, John K

Randall, John K is an individual health care provider with primary practice located at 124 Sagamore Pkwy W , West Lafayette IN 47906-1569. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Randall, John K can be contacted via phone (765) 463-6722.

Contact Information

Primary practice address
124 Sagamore Pkwy W West Lafayette IN 47906-1569
Phone: (765) 463-6722
Fax: (765) 463-0905
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 01042716 Indiana
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X 01042716 Indiana
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 01042716 Indiana

Profile Details

NPI number 1326076530
LBN Legal business name Randall, John K
Credentials RPH, MD
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2006
Last updated Mar 7th, 2023 - about last year

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 1326076530 NPPES
Indiana Other 000000092649 BCBS
Indiana Other 01042716 BCBS
Indiana MEDICAID 200207110A BCBS
Indiana MEDICAID 100415730A BCBS
Indiana Other 01042716B BCBS

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