Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301044697 | MI |
Y | 207VE0102X | Reproductive Endocrinologist | 4301044697 | MI |
NPI | 1174610943 |
---|---|
Provider Name | John F Randolph JR. |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48108-1649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1698685 | (05) | MI |
B49340 | (02) | MI |