Individual
AMBER TIFFANY RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
125.080109
IL
390200000X
Student in an Organized Health Care Education/Training Program
125.080109
IL
Other
Enumeration date
09/25/2018
Last updated
06/20/2023
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