Provider Demographics
NPI:1912053067
Name:LEDUC, RANDALL P (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:P
Last Name:LEDUC
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:12930 NORTH STREET
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018
Practice Address - Country:US
Practice Address - Phone:812-496-8783
Practice Address - Fax:812-432-3386
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041214A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64011372Medicaid
IN0401309OtherUNITED HEALTHCARE OF OHIO
IN646524OtherAETNA
IN5448484002OtherCIGNA
INN41214OtherHUMANA
IN000000031460OtherANTHEM
IN0401309OtherUNITED HEALTHCARE
IN100094220Medicaid
IN64011372OtherUNISYS
IN1349998OtherFIRST HEALTH
IN000000031460OtherANTHEM
IN100094220Medicaid
IN64011372OtherUNISYS
IN110170541Medicare PIN