Provider Demographics
NPI:1801897889
Name:RANDAZZO, RANDALL F (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:F
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 1:806 E WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4837
Mailing Address - Country:US
Mailing Address - Phone:847-278-1243
Mailing Address - Fax:847-466-7936
Practice Address - Street 1:806 E WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4837
Practice Address - Country:US
Practice Address - Phone:847-278-1243
Practice Address - Fax:847-466-7936
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-077481208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077481Medicaid
ILK27751Medicare PIN
ILIL4729001Medicare PIN
ILA93064Medicare UPIN