Provider Demographics
NPI:1861446940
Name:RANDY L. CLIMO, M.D., INC.
Entity Type:Organization
Organization Name:RANDY L. CLIMO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLIMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-345-0626
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43552-0424
Mailing Address - Country:US
Mailing Address - Phone:419-872-5848
Mailing Address - Fax:419-872-0855
Practice Address - Street 1:1725 TIMBER LINE RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4015
Practice Address - Country:US
Practice Address - Phone:419-345-0626
Practice Address - Fax:419-872-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057925C207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDF0382OtherRAILROAD MEDICARE
OH000000028370OtherANTHEM
OH2748978Medicaid
OH000000028370OtherANTHEM