| Dr Randy K Sulaver Ii, MD | |
|
302 W Hay St Ste 200, Decatur, IL 62526-4171 | |
| (217) 545-8000 | |
| (217) 872-1958 |
| Full Name | Dr Randy K Sulaver Ii |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Location | 302 W Hay St Ste 200, Decatur, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982968756 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 125061943 (Illinois) | Secondary |
| 208800000X | Urology | 036143964 (Illinois) | Primary |
| Entity Name | Siu Physicians & Surgeons Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558385989 PECOS PAC ID: 2365352820 Enrollment ID: O20031222000769 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Randy K Sulaver Ii, MD 201 E Madison St Ste 328, Springfield, IL 62702-5131 Ph: (217) 545-8000 | Dr Randy K Sulaver Ii, MD 302 W Hay St Ste 200, Decatur, IL 62526-4171 Ph: (217) 545-8000 |
Mr. Lee G Endsley, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 302 W Hay St, Ste 200, Decatur, IL 62526 Phone: 217-877-8925 Fax: 217-877-0020 | |
Thomas H Tarter, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 210 W Mckinley Ave Ste 1, Decatur, IL 62526 Phone: 217-876-6600 Fax: 217-876-6606 | |
Dr. Jeffrey R. Canham, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 302 W Hay St, Suite 200, Decatur, IL 62526 Phone: 217-877-8925 Fax: 217-877-0020 |