| Randall G. Shue D.o. Inc. | |
|
4055 E Olympic Blvd #210 Los Angeles CA 90023-3345 | |
| (323) 268-3491 | |
| Not Available |
| Full Name | Randall G. Shue D.o. Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 4055 E Olympic Blvd, Los Angeles, California |
| Authorized Official Name and Position | Randall G. Shue (OWNER) |
| Authorized Official Contact | 3232683491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall G. Shue D.o. Inc. 4055 E Olympic Blvd #210 Los Angeles CA 90023-3345 Ph: (323) 268-3491 | Randall G. Shue D.o. Inc. 4055 E Olympic Blvd #210 Los Angeles CA 90023-3345 Ph: (323) 268-3491 |
| NPI Number | 1770758187 |
|---|---|
| Provider Enumeration Date | 04/25/2008 |
| Last Update Date | 04/25/2008 |
| Medicare PECOS PAC ID | 8224089123 |
|---|---|
| Medicare Enrollment ID | O20050325000445 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770758187 | NPI | - | NPPES |
| 00AX5142 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A5142 (California) | Primary |
| Provider Name | Randall G Shue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679576730 PECOS PAC ID: 1658322557 Enrollment ID: I20050316001003 |
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