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NPI Code Detail

MEDICARE: DR. AMBER TIFFANY RANDOLPH MD

MEDICARE: DR. AMBER TIFFANY RANDOLPH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician036.178700IL

General Provider Information

NPI Number : 1194200121
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMBER TIFFANY RANDOLPH MD
Provider Business Mailing Address
First Line : 1009 S WOOD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3747
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1009 S WOOD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3747
Country : US
Telephone Number : 312-996-7445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2018
Last Update Date : 05/19/2026

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