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Organization
RANDOLPH COMMUNITY CLINIC SC
Active
Organization
RANDOLPH COMMUNITY CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA ELAINE LUCARELLI MD (PRESIDENT)
(920) 326-5060
Entity
Organization
Contact information
Practice address
504 S HIGH STREET, RANDOLPH, WI 53956
(920) 326-5060
(920) 326-5061
Mailing address
504 S HIGH ST, PO BOX 101, RANDOLPH, WI 53956-1499
(920) 326-5060
(920) 326-5061
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36988020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32327000
—
WI
01
—
CH8761
RAILROAD MEDICARE
—
01
—
N96
DEAN HEALTH PLAN
—
Enumeration date
11/01/2006
Last updated
04/20/2008
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