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Individual
MARK E. RANDAK
Active
Individual
MARK E. RANDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4396
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000013630
BCBS PIN
MT
01
—
0011322
MDCD PIN
MT
01
—
103703000
MDCD PIN
WY
Enumeration date
11/06/2006
Last updated
12/11/2014
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