Individual
DR. RANDOLPH CHRISTIANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
422 W WHITE ST, CLINTON, IL 61727-2272
(217) 935-9570
Mailing address
48 CHESTNUT CT, CHAMPAIGN, IL 61822-7121
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059930-1
—
IL
01
—
05721369
BC/BS
IL
Enumeration date
06/29/2006
Last updated
07/08/2007
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