Provider Demographics
NPI:1922085612
Name:HINRICHS, RANDALL L (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:HINRICHS
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 1:23708 CEDAR JONES RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:IA
Mailing Address - Zip Code:52253-9027
Mailing Address - Country:US
Mailing Address - Phone:319-350-0552
Mailing Address - Fax:
Practice Address - Street 1:23708 CEDAR JONES RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:IA
Practice Address - Zip Code:52253-9027
Practice Address - Country:US
Practice Address - Phone:319-350-0552
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600791Medicaid
IA2305631Medicaid
26434OtherWELLMARK OF IA
26434OtherWELLMARK OF IA
A01589Medicare UPIN