Healthcare Provider Details

I. General information

NPI: 1689625246
Provider Name (Legal Business Name): RANDALL M TOIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 114
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 114
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-440-1600
  • Fax: 312-440-3508
Mailing address:
  • Phone: 312-440-1600
  • Fax: 312-440-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036057210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: