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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

NPI Number 1245340488
LBN Legal business name RANDALL DERMATOLOGY, PC
Authorized official JOHN RANDALL - (PRESIDENT/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/30/2006
Last updated 12/19/2024 - More than a year ago
Identifiers
IN License # 01042716
IN License # 10000699A
IN License # 71001017A
IN License # 710013695B
IN Medicaid 200207110A
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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