Provider Demographics
NPI:1821693656
Name:MIRACLES OF LIFE OB/GYN, PLLC
Entity Type:Organization
Organization Name:MIRACLES OF LIFE OB/GYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRODNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-327-0531
Mailing Address - Street 1:150 COURTHOUSE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2450
Mailing Address - Country:US
Mailing Address - Phone:304-327-0531
Mailing Address - Fax:304-324-0548
Practice Address - Street 1:150 COURTHOUSE RD STE 202
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2450
Practice Address - Country:US
Practice Address - Phone:304-327-0531
Practice Address - Fax:304-324-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty