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Individual

RANDALL J CAMMENGA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 523-3161
(574) 523-3221
Mailing address
3371 CLEVELAND ROAD EXT, SUITE 210, SOUTH BEND, IN 46628-9780
(574) 271-2558
(574) 273-1137

Taxonomy

Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
01041177
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000082225
AANTHEM
IN
Enumeration date
07/29/2005
Last updated
03/20/2008
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