Individual
DR. RANDALL JOSEPH PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7221 ENGLE RD STE 220, FORT WAYNE, IN 46804-2233
(260) 432-1568
(260) 432-4969
Mailing address
7221 ENGLE RD STE 220, FORT WAYNE, IN 46804-2233
(260) 432-1568
(260) 432-4969
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01042709
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100389260
—
IN
05
—
1124099395
—
MI
05
—
2038280
—
OH
Enumeration date
01/27/2006
Last updated
05/24/2024
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