Individual
RANDOLPH J KNIFIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3680 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
Mailing address
3660 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME50388
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04139
BCBS
—
05
—
046689100
—
FL
01
—
0624238
AETNA HMO
—
01
—
4129913
AETNA PPO
—
01
—
ME50388
FLORIDA LICENSE
FL
Enumeration date
05/22/2006
Last updated
05/28/2008
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