Randall, Jerome R
Randall, Jerome R is an sole proprietor health care provider with primary practice located at 231 Main St , Park Forest IL 60466-2097. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Randall, Jerome R can be contacted via phone (708) 748-3338.Contact Information
Primary practice address
231 Main St
Park Forest IL 60466-2097
Phone: (708) 748-3338
Fax: (708) 748-4332
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 016-005113 | Illinois |
Profile Details
| NPI number | 1376689257 |
|---|---|
| LBN Legal business name | Randall, Jerome R |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 29th, 2007 |
| Last updated | Jul 5th, 2025 - about last year |
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 | 1376689257 | NPPES |
| Illinois | MEDICAID | 016005113 |
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