Individual
ELIZABETH A RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
5031 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-3453
(618) 212-6800
Mailing address
5031 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-3453
(618) 212-6800
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085.004815
IL
Other
Enumeration date
09/20/2013
Last updated
09/20/2013
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