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:
Health care specialties
| Specialty | Code | License # | 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 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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