Individual
TIENNE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8051 S EMERSON AVE STE 400, INDIANAPOLIS, IN 46237-8633
(317) 865-3600
(317) 885-3850
Mailing address
8051 S EMERSON AVE STE 400, INDIANAPOLIS, IN 46237-8633
(317) 865-3600
(317) 885-3850
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01078766A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01078766A
LICENSE
IN
05
—
300017269
—
IN
Enumeration date
06/11/2013
Last updated
03/04/2025
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