Provider Demographics
NPI:1831216258
Name:DEAN, RANDY (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:E-4111 ANDOVER ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1909
Mailing Address - Country:US
Mailing Address - Phone:248-290-5400
Mailing Address - Fax:248-290-5401
Practice Address - Street 1:E-4111 ANDOVER ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1909
Practice Address - Country:US
Practice Address - Phone:248-290-5400
Practice Address - Fax:248-290-5401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43014073782084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry