Provider Demographics
NPI:1093711517
Name:MCCOOL, RANDY (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:MCCOOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2407
Mailing Address - Country:US
Mailing Address - Phone:847-394-3553
Mailing Address - Fax:847-394-3574
Practice Address - Street 1:1630 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2407
Practice Address - Country:US
Practice Address - Phone:847-394-3553
Practice Address - Fax:847-394-3574
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1088086OtherPASSPORT
KY160034075OtherRAILROAD MEDICARE
KY64319007Medicaid
KY64319007Medicaid
KY1088086OtherPASSPORT