Randall, Mark Steven

Randall, Mark Steven is an individual health care provider with primary practice located at 8075 North Shadeland Avenue , Indianapolis IN 46256-2693. He recently has only one registered license in Behavioral Health & Social Service Providers / Health Service, which is considered as his primary health care specialty. Randall, Mark Steven can be contacted via phone (317) 621-8000.

Contact Information

Primary practice address
8075 North Shadeland Avenue Indianapolis IN 46256-2693
Phone: (317) 621-8000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Health Service 103TH0100X 20041703A Indiana

Profile Details

NPI number 1538161351
LBN Legal business name Randall, Mark Steven
Credentials PSYD HSPP
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated Mar 10th, 2011 - about 13 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 1538161351 NPPES
Indiana Other 680016092 RAILROAD MEDICARE
Indiana MEDICAID 200305690 RAILROAD MEDICARE

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