Randolph, Geoffrey M
Randolph, Geoffrey M is an individual health care provider with primary practice located at 11141 Parkview Plaza Dr Ste 300 , Fort Wayne IN 46845-1715. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Randolph, Geoffrey M can be contacted via phone (260) 490-7111.Contact Information
Primary practice address
11141 Parkview Plaza Dr Ste 300
Fort Wayne IN 46845-1715
Phone: (260) 490-7111
Fax: (260) 490-9301
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Plastic Surgery | 208200000X | 01035742A | Indiana |
Profile Details
| NPI number | 1194726380 |
|---|---|
| LBN Legal business name | Randolph, Geoffrey M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 10th, 2005 |
| Last updated | Jul 23rd, 2018 - about 6 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 | 1194726380 | NPPES |
| Indiana | Other | 240007528 | MEDICARE RAILROAD |
| Indiana | MEDICAID | 104366820 | MEDICARE RAILROAD |
| Indiana | MEDICAID | 0467338 | MEDICARE RAILROAD |
| Indiana | MEDICAID | 100353210 | MEDICARE RAILROAD |
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