Provider Demographics
NPI:1164740270
Name:WOODFIELD UROLOGY
Entity Type:Organization
Organization Name:WOODFIELD UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-364-4990
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 2005
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3364
Mailing Address - Country:US
Mailing Address - Phone:847-364-4990
Mailing Address - Fax:847-364-4993
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 2005
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3364
Practice Address - Country:US
Practice Address - Phone:847-364-4990
Practice Address - Fax:847-364-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4729Medicare PIN