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Individual

RANDALL ORA CARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 545-4456
Mailing address
320 E MAIN ST, CROSBY, MN 56441-1645
(218) 546-7000
(218) 545-4456

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37087
MN
207Q00000X
Family Medicine Physician
4301058040
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4255760
MI
Enumeration date
10/28/2005
Last updated
12/12/2012
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