Provider Demographics
NPI:1659319523
Name:HINKLE, RANDY LEE (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:HINKLE
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 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 POLARIS PKWY
Practice Address - Street 2:STE 3000
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7989
Practice Address - Country:US
Practice Address - Phone:614-533-3354
Practice Address - Fax:614-533-3377
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-006223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018300Medicaid
OH080107309OtherRAILROAD MEDICARE PIN
OHG53646Medicare UPIN
OH2018300Medicaid