Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 01023836 | IN |
NPI | 1073621033 |
---|---|
Provider Name | Randall L Caldwell |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 17/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000354895 | ANTHEM-DEAC-350593390 (01) | |
0472902 | (05) | OH |
100061190 | (05) | IN |
1073621033 | (05) | MI |
350593390-042 | TRICARE-DEAC-350593390 (01) | |
64882236 | (05) | KY |
C24322 | (02) |