Provider Demographics
NPI:1861451502
Name:MACURAK, RANDAL BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:BRUCE
Last Name:MACURAK
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 1:8267 ELMBROOK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4078
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:3430 W. WHEATLAND ROAD
Practice Address - Street 2:CHARLTON I POB, SUITE 109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:972-296-1983
Practice Address - Fax:972-296-2290
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6132207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83Y771OtherBCBSTX
TX099720702Medicaid
TX100007731Medicare PIN
TX099720702Medicaid
TX83Y771Medicare PIN