Provider Demographics
NPI:1003828682
Name:TODD, RANDALL M (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:M
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7112
Mailing Address - Street 2:DEPT. #31
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46207-7112
Mailing Address - Country:US
Mailing Address - Phone:866-516-2307
Mailing Address - Fax:888-516-2306
Practice Address - Street 1:8111 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8601
Practice Address - Country:US
Practice Address - Phone:317-528-5261
Practice Address - Fax:317-528-5026
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01035235207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100325030Medicaid
D95716Medicare UPIN
IN339250HMedicare PIN