Organization
RANDOM LAKE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARBARA A WEBER MD (OWNER)
(920) 994-9999
Entity
Organization
Contact information
Practice address
N639 SILVER CREEK CASCADE ROAD, RANDOM LAKE, WI 53075
(920) 994-9999
(920) 994-9998
Mailing address
PO BOX 246, N639 SILVER CREEK CASCADE RD, RANDOM LAKE, WI 53075
(920) 994-9999
(920) 994-9998
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39774
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32420000
—
WI
Enumeration date
05/01/2007
Last updated
08/22/2020
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