Randall, Jerome R
Randall, Jerome R is an sole proprietor health care provider with primary practice located at 19900 Governors Dr #12, Olympia Fields IL 60461-1057. 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) 898-2380.Contact Information
Primary practice address
19900 Governors Dr #12
Olympia Fields IL 60461-1057
Phone: (708) 898-2380
Fax: (708) 898-2326
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 | Aug 17th, 2022 - about 4 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 | 1376689257 | NPPES |
| Illinois | MEDICAID | 016005113 |
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