Provider Demographics
NPI:1982662326
Name:RANDAZZO, FRANK A (MD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:A
Last Name:RANDAZZO
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 1:36175 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3274
Mailing Address - Country:US
Mailing Address - Phone:586-741-3772
Mailing Address - Fax:
Practice Address - Street 1:36175 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3274
Practice Address - Country:US
Practice Address - Phone:586-741-3772
Practice Address - Fax:586-741-4604
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010760572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26008OtherBLUE CARE NETWORK
MI0Q26008OtherBCBS OF MICHIGAN
MI495680OtherHAP
P00329839OtherRR MEDICARE
MI0H26188OtherBCBS OF MICHIGAN
MISJ820005OtherMCARE
1111920004OtherWELLNESS PLAN
MI1006439OtherMCCLAREN
MI4864780Medicaid
MI0Q26008OtherBLUE CARE NETWORK