Basic Information
| Provider Information | |||||||||
| NPI: | 1518948389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANDLEMAN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15797 CARTER ST | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500473194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159893133 | ||||||||
| FaxNumber: | 5159899387 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 6TH AVE | ||||||||
| Address2: | EMERGENCY MEDICINE | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152474445 | ||||||||
| FaxNumber: | 5156438933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1997 | IA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3208447 | 05 | IA | MEDICAID |