Individual
RANDOLPH S MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3210
(217) 383-3510
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
(217) 902-5292
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036079474
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079474
—
IL
Enumeration date
09/09/2005
Last updated
04/06/2020
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