Provider Demographics
NPI:1609863281
Name:RICH, RANDY S (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:S
Last Name:RICH
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 1:25070 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1250
Mailing Address - Country:US
Mailing Address - Phone:847-585-7000
Mailing Address - Fax:847-240-0622
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 8200
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-259-4482
Practice Address - Fax:847-259-6406
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091959207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091959Medicaid
IL830007370Medicare PIN
ILH43869Medicare UPIN
ILL84881Medicare PIN
IL355031Medicare PIN
IL355030Medicare PIN
ILL84882Medicare PIN
ILT01491Medicare PIN
ILL84883Medicare PIN
IL036091959Medicaid