Michelle Randolph Md Pc | |
2741 Debarr Road Suite 402 Anchorage AK 99508 | |
(907) 531-5213 | |
(907) 531-5013 |
Full Name | Michelle Randolph Md Pc |
---|---|
Speciality | Internal Medicine |
Location | 2741 Debarr Road Suite 402, Anchorage, Alaska |
Authorized Official Name and Position | Michelle Lisa Randolph (PRESIDENT) |
Authorized Official Contact | 8082956058 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Michelle Randolph Md Pc 2741 Debarr Road Suite 402 Anchorage AK 99508 Ph: (907) 531-5213 | Michelle Randolph Md Pc 2741 Debarr Road Suite 402 Anchorage AK 99508 Ph: (907) 531-5213 |
NPI Number | 1578806436 |
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Provider Enumeration Date | 03/29/2013 |
Last Update Date | 10/28/2020 |
Medicare PECOS PAC ID | 4486896404 |
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Medicare Enrollment ID | O20130805000075 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578806436 | NPI | - | NPPES |
1583849 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
261QM2500X | Clinic/center - Medical Specialty | 7641 (Alaska) | Secondary |
Provider Name | Michelle L Randolph |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1346209756 PECOS PAC ID: 6406939701 Enrollment ID: I20130805000125 |
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