Healthcare Provider Details

I. General information

NPI: 1760649685
Provider Name (Legal Business Name): RANDY EILERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

IV. Provider business mailing address

5619 E 49TH ST N
BEL AIRE KS
67220-1479
US

V. Phone/Fax

Practice location:
  • Phone: 620-665-2000
  • Fax:
Mailing address:
  • Phone: 316-833-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6933
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0435030
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: