Provider Demographics
NPI:1982968756
Name:SULAVER, RANDY K II (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:K
Last Name:SULAVER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:201 E MADISON ST STE 328
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5131
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:
Practice Address - Street 1:302 W HAY ST STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4171
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-872-1958
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125061943208800000X
IL036143964208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology