Individual
MR. RANDY L PURCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
205 VALLEY AVE, WEST BEND, WI 53095-5312
(262) 338-1123
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
322-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42906500
—
WI
Enumeration date
08/23/2006
Last updated
12/03/2012
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