Provider Demographics
NPI:1952361610
Name:READLING, RANDY D (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:READLING
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 1:4525 N RAVENSWOOD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5201
Mailing Address - Country:US
Mailing Address - Phone:312-857-8794
Mailing Address - Fax:708-575-8311
Practice Address - Street 1:320 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5918
Practice Address - Country:US
Practice Address - Phone:920-832-5270
Practice Address - Fax:920-832-4767
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1477642084P0800X
WI11602084P0800X
NC93-002922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9300292OtherNC MEDICAL LICENSE
IL036.147764OtherIL MEDICAL LICENSE
WI1160OtherWI MEDICAL LICENSE
NC93-00292OtherMEDICAL LICENSE NUMBER
NC93-00292OtherMEDICAL LICENSE NUMBER