Provider Demographics
NPI:1619918448
Name:RANDA, DANIEL CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CRAIG
Last Name:RANDA
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 1:3833 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2697
Mailing Address - Country:US
Mailing Address - Phone:763-427-8320
Mailing Address - Fax:763-302-4338
Practice Address - Street 1:3833 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2697
Practice Address - Country:US
Practice Address - Phone:763-427-8320
Practice Address - Fax:763-302-4338
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213182084N0400X
WI274892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100297C029OtherUCARE
MN14275RAOtherBCBS OF MN
WI30204000Medicaid
MN916763300Medicaid
MNHP14220OtherHEALTHPARTNERS
MN0265013OtherPREFERRED ONE
MN130004697OtherRAILROAD MEDICARE
MN22679OtherAMERICA'S PPO
MN0501738OtherMEDICA
MN0501738OtherMEDICA
MN14275RAOtherBCBS OF MN
MN22679OtherAMERICA'S PPO