Individual
SHERON M RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8150 OAKLANDON RD STE 130, INDIANAPOLIS, IN 46236-9554
(317) 621-1111
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
(317) 621-7584
(317) 957-2705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01047330A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000744272
BCBS
IN
05
—
200328390
—
IN
01
—
P01424263
RAIL ROAD PTAN
IN
Enumeration date
07/27/2006
Last updated
12/05/2024
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