Individual
KYLE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
715 RICHLAND MALL, ONTARIO, OH 44906-3802
(419) 709-8645
Mailing address
700 N COLUMBUS ST, CRESTLINE, OH 44827-1455
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
35.124114
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2197144
—
OH
Enumeration date
04/04/2008
Last updated
01/25/2021
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