Roller, Randolph W.

Roller, Randolph W. is an individual health care provider with primary practice located at 1025 S 6Th St , Springfield IL 62703-2403. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecology, which is considered as his primary health care specialty. Roller, Randolph W. can be contacted via phone (217) 528-7541.

Contact Information

Primary practice address
1025 S 6Th St Springfield IL 62703-2403
Phone: (217) 528-7541
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 036-054648 Illinois

Profile Details

NPI number 1386744068
LBN Legal business name Roller, Randolph W.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 23rd, 2006
Last updated Aug 19th, 2008 - about 18 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 1386744068 NPPES
Illinois MEDICAID 0360546648

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