Provider Demographics
NPI:1518948389
Name:RANDLEMAN, MARK EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:RANDLEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:15797 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-3194
Mailing Address - Country:US
Mailing Address - Phone:515-989-3133
Mailing Address - Fax:515-989-9387
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:EMERGENCY MEDICINE
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2610
Practice Address - Country:US
Practice Address - Phone:515-247-4445
Practice Address - Fax:515-643-8933
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA1997207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3208447Medicaid
IA3208447Medicaid
IAA02765Medicare UPIN