Individual
RANDOLPH ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 S MAIN ST, CROWN POINT, IN 46307-8481
(219) 757-6320
(219) 738-6714
Mailing address
55 E 86TH AVE, PO BOIX 10645, MERRILLVILLE, IN 46410-6382
(219) 769-1670
(219) 738-6714
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01036988
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200005040
—
IN
Enumeration date
09/30/2005
Last updated
01/25/2012
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