Provider Demographics
NPI:1770564924
Name:CHUDLER, RANDY M (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:M
Last Name:CHUDLER
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 1:1569 SODON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2361
Mailing Address - Country:US
Mailing Address - Phone:248-626-9056
Mailing Address - Fax:
Practice Address - Street 1:1569 SODON LAKE DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2361
Practice Address - Country:US
Practice Address - Phone:248-626-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055681208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06273OtherBCBSM
MICB9133OtherRAILROAD MEDICARE
MI0E06273OtherBCBSM
MI0219690010Medicare NSC
MICB9133OtherRAILROAD MEDICARE