Provider Demographics
NPI:1033169685
Name:RANDALL MCCORMICK TOLEDO INTERNAL MEDICINE SPEC INC
Entity Type:Organization
Organization Name:RANDALL MCCORMICK TOLEDO INTERNAL MEDICINE SPEC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-251-7672
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43697-0505
Mailing Address - Country:US
Mailing Address - Phone:419-251-7672
Mailing Address - Fax:419-251-6785
Practice Address - Street 1:2409 CHERRY ST
Practice Address - Street 2:STE 207
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2625
Practice Address - Country:US
Practice Address - Phone:419-251-7672
Practice Address - Fax:419-251-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2610302Medicaid
OH9358131Medicare PIN
OH2610302Medicaid