Provider Demographics
NPI:1558502468
Name:FIETE, RANDALL LEE (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:FIETE
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 1:980 E TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-7950
Mailing Address - Country:US
Mailing Address - Phone:414-571-9680
Mailing Address - Fax:
Practice Address - Street 1:980 E TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-7950
Practice Address - Country:US
Practice Address - Phone:414-571-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics