Provider Demographics
NPI:1750432373
Name:BARDEN, RANDALL GEORGE
Entity type:Individual
Prefix:MS
First Name:RANDALL
Middle Name:GEORGE
Last Name:BARDEN
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 1:22777 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2036
Mailing Address - Country:US
Mailing Address - Phone:586-773-3300
Mailing Address - Fax:585-773-2232
Practice Address - Street 1:4 E ALEXANDRINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2031
Practice Address - Country:US
Practice Address - Phone:586-773-3300
Practice Address - Fax:586-773-2232
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000203231H00000X
MI3501001250237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4598478Medicaid
MI4681850Medicaid
MI4681959Medicaid
MI4698496Medicaid
MI4598389Medicaid
MI4681879Medicaid
MI4681897Medicaid
MI4681912Medicaid
MI4598422Medicaid
MI4598440Medicaid
MI4681888Medicaid
MI4682025Medicaid
MI4508487Medicaid
MI4598431Medicaid
MI4681921Medicaid
MI4598360Medicaid
MI4681903Medicaid
MI4681968Medicaid
MI4681850Medicaid
MI4681959Medicaid