Provider Demographics
NPI:1548225600
Name:VOIGTS, RANDALL A (DO)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:A
Last Name:VOIGTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052
Mailing Address - Country:US
Mailing Address - Phone:618-498-7518
Mailing Address - Fax:618-498-3052
Practice Address - Street 1:205 S MORSE ST
Practice Address - Street 2:
Practice Address - City:ROADHOUSE
Practice Address - State:IL
Practice Address - Zip Code:62082
Practice Address - Country:US
Practice Address - Phone:217-589-4383
Practice Address - Fax:217-589-4409
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL080020747OtherMEDICARE RAILROAD
IL036071356Medicaid
IL784330Medicare ID - Type Unspecified
C47442Medicare UPIN