Individual
DR. RANDOLPH EDWARD SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 W MAGNETIC ST, MARQUETTE, MI 49855-2711
(906) 228-9440
Mailing address
420 W MAGNETIC ST, MARQUETTE, MI 49855-2711
(906) 228-9440
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301046452
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022271
PREFERRED ONE
MI
01
—
2746496
MOLINA HEALTHCARE
MI
01
—
2746796
HEALTHPLAN OF MI
MI
05
—
2746796
—
MI
05
—
34031400
—
WI
Enumeration date
11/30/2006
Last updated
09/04/2007
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