Randall L Wolthuis, PHD is a medicare enrolled "Psychologist - Clinical" provider in Alto, Michigan. His current practice location is
8202 Triple L Trl Se, Alto, Michigan. You can reach out to his office (for appointments etc.) via phone at
(616) 275-2113.
Randall L Wolthuis is licensed to practice in Michigan (license number 6301006480) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1639390743.
Healthcare Provider's Profile
| Full Name | Randall L Wolthuis |
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| Gender | Male |
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| Speciality | Psychologist - Clinical |
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| Location | 8202 Triple L Trl Se, Alto, Michigan |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1639390743
- Provider Enumeration Date: 05/02/2007
- Last Update Date: 03/21/2024
Medicare PECOS Information:
- PECOS PAC ID: 2365488509
- Enrollment ID: I20050628001231
Medical Identifiers
Medical identifiers for Randall L Wolthuis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1639390743 | NPI | - | NPPES |
| 680D145940 | Other | MI | BCBS PIN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 103TC0700X | Psychologist - Clinical | 6301006480 (Michigan) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Randall L Wolthuis is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Randall L Wolthuis, PHD 1000 Parchment Drive Se, Grand Rapids, MI 49546-3663 Ph: (616) 957-9112 | Randall L Wolthuis, PHD 8202 Triple L Trl Se, Alto, MI 49302-9551 Ph: (616) 275-2113 |
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