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Contact Information

RANDALL DERMATOLOGY, PC
124 SAGAMORE PKWY W
WEST LAFAYETTE, IN47906-1569
 Phone: 765-463-6722
 Fax: 765-463-0905
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for RANDALL DERMATOLOGY PC · (Female)

NPI Number 1245340488
Status Active
Credentials
Entity Individual
Enumeration date 08/30/2006
Last updated 12/19/2024 - More than a year ago
Sole proprietor 1 Not specified
Identifiers
  • IN License # 01042716
  • IN License # 10000699A
  • IN License # 71001017A
  • IN License # 710013695B
  • IN Medicaid 200207110A
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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