Provider Demographics
NPI:1255919593
Name:HAROLD, RANDY D
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:HAROLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0411
Mailing Address - Country:US
Mailing Address - Phone:517-887-0226
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0411
Practice Address - Country:US
Practice Address - Phone:517-887-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist