Provider Demographics
NPI:1639893837
Name:DAULTON, RANDY R (RRT)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:R
Last Name:DAULTON
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GREEN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1573
Mailing Address - Country:US
Mailing Address - Phone:734-222-4277
Mailing Address - Fax:734-222-4383
Practice Address - Street 1:2500 GREEN RD STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1573
Practice Address - Country:US
Practice Address - Phone:734-222-4277
Practice Address - Fax:734-222-4383
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI44010020642279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care