Individual
DR. MICHAEL SHANE RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 HARDIN LN, SOMERSET, KY 42503-3800
(606) 676-0786
Mailing address
3750 KY HWY 2141, STANFORD, KY 40484
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33885
KY
Other
Enumeration date
09/06/2006
Last updated
07/08/2007
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