| 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 |
|---|---|
| Provider Enumeration Date | 03/29/2013 |
| Last Update Date | 10/28/2020 |
| Certification Date | 10/28/2020 |
| Medicare PECOS PAC ID | 4486896404 |
|---|---|
| Medicare Enrollment ID | O20130805000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578806436 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | () | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | 7641 (Alaska) | Secondary |
| Provider Name | Michelle L Randolph |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1346209756 PECOS PAC ID: 6406939701 Enrollment ID: I20130805000125 |
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