Provider Demographics
NPI:1225082399
Name:CLIMO, RANDY LEE (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:CLIMO
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:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-8207
Mailing Address - Country:US
Mailing Address - Phone:419-482-0592
Mailing Address - Fax:419-482-5529
Practice Address - Street 1:1655 HOLLAND RD
Practice Address - Street 2:SUITE D
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1656
Practice Address - Country:US
Practice Address - Phone:419-482-0592
Practice Address - Fax:419-482-5529
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057925C207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0771151Medicaid
OH0004127117OtherAETNA
OH22000000028370OtherANTHEM
OH01162OtherPARAMOUNT HEALTHCARE
OH34163460300OtherBWC
OH0771151Medicaid
OH01162OtherPARAMOUNT HEALTHCARE