Provider Demographics
NPI:1770695983
Name:HOLDEN, RANDALL WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:WILLIAM
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R.
Other - Middle Name:WILLIAM
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3793 SUNDRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1264
Mailing Address - Country:US
Mailing Address - Phone:989-497-0466
Mailing Address - Fax:989-497-0466
Practice Address - Street 1:3793 SUNDRIDGE PL
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1264
Practice Address - Country:US
Practice Address - Phone:989-497-0466
Practice Address - Fax:989-497-0466
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010366292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology