Individual
GREG C RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17599 KENWOOD TRL, LAKEVILLE, MN 55044-8330
(952) 985-8600
(952) 985-8699
Mailing address
7801 E BUSH LAKE RD, STE 300, BLOOMINGTON, MN 55439-3120
(952) 985-8911
(952) 985-8999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28794
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
351278900
—
MN
Enumeration date
08/15/2005
Last updated
03/10/2021
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