Randolph, Laura C

Randolph, Laura C is an sole proprietor health care provider with primary practice located at 2502 E Empire St Suite C, Bloomington IL 61704-3738. She recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as her primary health care specialty. Randolph, Laura C can be contacted via phone (309) 664-6222.

Contact Information

Primary practice address
2502 E Empire St Suite C Bloomington IL 61704-3738
Phone: (309) 664-6222
Fax: (309) 664-5006
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 36-100030 Illinois

Profile Details

NPI number 1710906557
LBN Legal business name Randolph, Laura C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 19th, 2006
Last updated Sep 12th, 2013 - about 12 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 1710906557 NPPES
Illinois MEDICAID 036100030
Illinois Other 097565
Illinois Other P00193845
Illinois Other 5732066
Illinois Other 686867

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