Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 38252 | IA |
Y | 2080P0214X | Pediatric Pulmonologist | 38252 | IA |
N | 2080P0214X | Pediatric Pulmonologist | R-7448 | IA |
NPI | 1407065469 |
---|---|
Provider Name | Christoph O. Randak |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 20/03/2009 |