MEDICARE: DR. RANDY PETER PLONA 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
1	207Q00000X	Family Medicine Physician	34007598P	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341542312098	OTHER	OH	CARESOURCE
2	000000392507	OTHER	OH	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	378646	OTHER	OH	WELLCARE
5	P00401083	OTHER	OH	RAILROAD CARE

General Provider Information

NPI Number	:	1699722702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY PETER PLONA MD

Provider Business Mailing Address
First Line	:	PO BOX 74224
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44194-0002
Country	:	US
Telephone Number	:	216-383-6480
Fax Number	:	216-383-6745

Provider Business Practice Location Address
First Line	:	960 CLAGUE RD STE 1100B
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1590
Country	:	US
Telephone Number	:	216-383-0100
Fax Number	:	216-383-6481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	05/02/2008

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