Provider Demographics
NPI:1497212328
Name:RANDLE, DANIEL J (AS, CAPRC2)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:RANDLE
Suffix:
Gender:M
Credentials:AS, CAPRC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1443
Mailing Address - Country:US
Mailing Address - Phone:317-550-3737
Mailing Address - Fax:
Practice Address - Street 1:1800 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1443
Practice Address - Country:US
Practice Address - Phone:317-550-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health