Healthcare Provider Details

I. General information

NPI: 1356550123
Provider Name (Legal Business Name): RANDY S. MORRIS, MD, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 N. WASHINGTON ST.
NAPERVILLE IL
60540
US

IV. Provider business mailing address

3 N. WASHINGTON ST.
NAPERVILLE IL
60540
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-6540
  • Fax: 630-357-6435
Mailing address:
  • Phone: 630-357-6540
  • Fax: 630-357-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number04261700
License Number StateIL

VIII. Authorized Official

Name: RANDY S. MORRIS
Title or Position: OWNER
Credential: M.D.
Phone: 630-357-6540