Provider Demographics
NPI:1619968765
Name:SALIARES, RANDY C (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:C
Last Name:SALIARES
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-240-2205
Mailing Address - Fax:320-229-5174
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-240-2205
Practice Address - Fax:320-229-5174
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27076207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110917OtherUCARE
492R2SAOtherBLUE CROSS BLUE SHIELD
600821OtherARAZ GROUP AMERICAS PPO
986027OtherPREFERRED ONE
6D087SAOtherBLUE CROSS BLUE SHIELD
2900210OtherMEDICA HEALTH PLANS
2114028OtherFIRST HEALTH PLAN
716268500OtherMEDICAL ASSISTANCE
HP25511OtherHEALTH PARTNERS
HP25511OtherHEALTH PARTNERS
600821OtherARAZ GROUP AMERICAS PPO
MNBS0781509OtherDEA